Provider Demographics
NPI:1316372600
Name:PATRICIA DENTON-EDWARDS LLC
Entity Type:Organization
Organization Name:PATRICIA DENTON-EDWARDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTON-EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LSCSW, LCAC
Authorized Official - Phone:785-477-0300
Mailing Address - Street 1:5706 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-9701
Mailing Address - Country:US
Mailing Address - Phone:785-477-0300
Mailing Address - Fax:
Practice Address - Street 1:5706 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-9701
Practice Address - Country:US
Practice Address - Phone:785-477-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS90101YA0400X
KS41081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty