Provider Demographics
NPI:1356648273
Name:THE CENTER FOR SOCIAL WORK INNOVATION, LLC
Entity Type:Organization
Organization Name:THE CENTER FOR SOCIAL WORK INNOVATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TAUNYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUTENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-253-8303
Mailing Address - Street 1:3425 W CENTRAL AVE STE 100-102
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4919
Mailing Address - Country:US
Mailing Address - Phone:316-253-8303
Mailing Address - Fax:316-946-0694
Practice Address - Street 1:3425 W CENTRAL AVE STE 100-102
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4919
Practice Address - Country:US
Practice Address - Phone:316-253-8303
Practice Address - Fax:316-946-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty