| Michelle Oliphant, Llc | |
|
4601 E Douglas Ave Ste 120 Wichita KS 67218-1032 | |
| (316) 500-3711 | |
| Not Available |
| Full Name | Michelle Oliphant, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4601 E Douglas Ave Ste 120, Wichita, Kansas |
| Authorized Official Name and Position | Michelle Oliphant (SOLE OWNER) |
| Authorized Official Contact | 3165003711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michelle Oliphant, Llc 4601 E Douglas Ave Ste 120 Wichita KS 67218-1032 Ph: (131) 650-03711 | Michelle Oliphant, Llc 4601 E Douglas Ave Ste 120 Wichita KS 67218-1032 Ph: (316) 500-3711 |
| NPI Number | 1144744723 |
|---|---|
| Provider Enumeration Date | 07/26/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144744723 | NPI | - | NPPES |
| 201157740A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 10366 (Kansas) | Primary |
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