Provider Demographics
NPI:1255686275
Name:LINDA CRENSHAW, LMSW
Entity Type:Organization
Organization Name:LINDA CRENSHAW, LMSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-519-0673
Mailing Address - Street 1:PO BOX 20733
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-6733
Mailing Address - Country:US
Mailing Address - Phone:316-519-0673
Mailing Address - Fax:
Practice Address - Street 1:127 E AVENUE B
Practice Address - Street 2:SUITE B
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-7422
Practice Address - Country:US
Practice Address - Phone:620-259-7993
Practice Address - Fax:620-259-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7744104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200653890AMedicaid