Provider Demographics
NPI:1518476589
Name:MKC COUNSELING, LLC
Entity Type:Organization
Organization Name:MKC COUNSELING, LLC
Other - Org Name:MKC COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDES
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCP
Authorized Official - Phone:316-371-7226
Mailing Address - Street 1:1307 N COACH HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-9706
Mailing Address - Country:US
Mailing Address - Phone:316-371-7226
Mailing Address - Fax:
Practice Address - Street 1:654 N WOODCHUCK ST STE F
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3571
Practice Address - Country:US
Practice Address - Phone:316-371-7226
Practice Address - Fax:888-527-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2792103T00000X
103T00000X
KS46951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201134910AMedicaid