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2603 Central Ave Dodge City KS 67801-6210 | |
| (620) 253-2920 | |
| (620) 371-6570 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2603 Central Ave, Dodge City, Kansas |
| Authorized Official Name and Position | Trista Fergerson (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 5134903643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1884 Dodge City KS 67801-1884 Ph: (620) 253-2920 | 2603 Central Ave Dodge City KS 67801-6210 Ph: (620) 253-2920 |
| NPI Number | 1295341758 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 07/28/2021 |
| Certification Date | 07/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295341758 | NPI | - | NPPES |
| 201329860A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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