Provider Demographics
NPI:1245206846
Name:BROOKSIDE MENTAL HEALTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:BROOKSIDE MENTAL HEALTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW,CFT
Authorized Official - Phone:785-272-8808
Mailing Address - Street 1:3601 SW 29TH ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2078
Mailing Address - Country:US
Mailing Address - Phone:785-272-8808
Mailing Address - Fax:785-272-0814
Practice Address - Street 1:3601 SW 29TH ST
Practice Address - Street 2:SUITE 217
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2078
Practice Address - Country:US
Practice Address - Phone:785-272-8808
Practice Address - Fax:785-272-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS41081OtherGROUP- BC/BS
KS41083OtherBILLING PROVIDER #
KS41081OtherGROUP- BC/BS
KSPENDINGMedicare ID - Type UnspecifiedWAITING FOR NEW NUMBER