Provider Demographics
NPI:1013021401
Name:COUNSELING & MEDIATION CENTER INC
Entity Type:Organization
Organization Name:COUNSELING & MEDIATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MORPHIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, DMIN
Authorized Official - Phone:316-269-2322
Mailing Address - Street 1:200 W DOUGLAS AVE STE 560
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3020
Mailing Address - Country:US
Mailing Address - Phone:316-269-2322
Mailing Address - Fax:316-269-2448
Practice Address - Street 1:200 W DOUGLAS AVE STE 560
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-3020
Practice Address - Country:US
Practice Address - Phone:316-269-2322
Practice Address - Fax:316-269-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
KS1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20043041AMedicaid
KS20043041AMedicaid