Provider Demographics
NPI:1508274382
Name:JOHNSON COUNTY MENTAL HEALTH
Entity Type:Organization
Organization Name:JOHNSON COUNTY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEB
Authorized Official - Middle Name:
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC
Authorized Official - Phone:913-782-0283
Mailing Address - Street 1:1125 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3123
Mailing Address - Country:US
Mailing Address - Phone:913-782-0283
Mailing Address - Fax:913-782-0609
Practice Address - Street 1:1125 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3123
Practice Address - Country:US
Practice Address - Phone:913-782-0283
Practice Address - Fax:913-782-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1469324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility