| Countryside Counseling Center, Llc | |
|
601 Morningside Dr Independence KS 67301-1932 | |
| (620) 577-4955 | |
| (620) 577-4956 |
| Full Name | Countryside Counseling Center, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 601 Morningside Dr, Independence, Kansas |
| Authorized Official Name and Position | Debra Lynn Hastings (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6205774955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Countryside Counseling Center, Llc 601 Morningside Dr Independence KS 67301-1932 Ph: (620) 577-4955 | Countryside Counseling Center, Llc 601 Morningside Dr Independence KS 67301-1932 Ph: (620) 577-4955 |
| NPI Number | 1104100833 |
|---|---|
| Provider Enumeration Date | 09/29/2011 |
| Last Update Date | 09/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104100833 | NPI | - | NPPES |
| 200432330C | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 103T00000X (Kansas) | Primary |
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