Provider Demographics
NPI:1275860207
Name:WESTERN KANSAS CHILD ADVOCACY CENTER
Entity Type:Organization
Organization Name:WESTERN KANSAS CHILD ADVOCACY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:620-872-3706
Mailing Address - Street 1:109 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-1743
Mailing Address - Country:US
Mailing Address - Phone:620-872-3706
Mailing Address - Fax:
Practice Address - Street 1:109 E 9TH ST
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-1743
Practice Address - Country:US
Practice Address - Phone:620-872-3706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty