Provider Demographics
NPI:1083089627
Name:BEHAVIORAL GUIDANCE CENTER
Entity Type:Organization
Organization Name:BEHAVIORAL GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR.
Authorized Official - Prefix:
Authorized Official - First Name:LORRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAYZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-944-3940
Mailing Address - Street 1:PO BOX 17053
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-0053
Mailing Address - Country:US
Mailing Address - Phone:316-944-3940
Mailing Address - Fax:316-946-0694
Practice Address - Street 1:400 N WOODLAWN ST STE 30
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4333
Practice Address - Country:US
Practice Address - Phone:316-944-3940
Practice Address - Fax:316-946-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3789104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2805013OtherMEDICARE #
KS3789OtherLICENSE
KS200877570AMedicaid