| Deidre Manis, Llc | |
|
7807 E Funston St Wichita KS 67207-3123 | |
| (316) 636-1188 | |
| (316) 636-1190 |
| Full Name | Deidre Manis, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7807 E Funston St, Wichita, Kansas |
| Authorized Official Name and Position | Deidre Manis (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6208759656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deidre Manis, Llc 1041 N Meadow Rd Valley Center KS 67147-9400 Ph: (620) 875-9656 | Deidre Manis, Llc 7807 E Funston St Wichita KS 67207-3123 Ph: (316) 636-1188 |
| NPI Number | 1356947089 |
|---|---|
| Provider Enumeration Date | 12/08/2020 |
| Last Update Date | 12/08/2020 |
| Certification Date | 12/08/2020 |
| Medicare PECOS PAC ID | 4789097957 |
|---|---|
| Medicare Enrollment ID | O20210107000367 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356947089 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Deidre A Manis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023304193 PECOS PAC ID: 4587988977 Enrollment ID: I20150113000139 |
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