Provider Demographics
NPI:1497105829
Name:SECOND CHANCE SERVICES
Entity Type:Organization
Organization Name:SECOND CHANCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR AND THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:PD
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW, LAC, CMT
Authorized Official - Phone:785-608-3577
Mailing Address - Street 1:501 SE JEFFERSON ST STE 32
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66607-1173
Mailing Address - Country:US
Mailing Address - Phone:785-608-3577
Mailing Address - Fax:
Practice Address - Street 1:501 SE JEFFERSON ST STE 32
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-1173
Practice Address - Country:US
Practice Address - Phone:785-608-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1245251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health