Provider Demographics
NPI:1619331519
Name:FAMILY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:FAMILY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCP
Authorized Official - Phone:316-691-9711
Mailing Address - Street 1:6611 E CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1937
Mailing Address - Country:US
Mailing Address - Phone:316-260-4559
Mailing Address - Fax:316-358-7713
Practice Address - Street 1:6611 E CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1937
Practice Address - Country:US
Practice Address - Phone:316-260-4559
Practice Address - Fax:316-358-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP-927103TF0000X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200429840GMedicaid
KS200429840DMedicaid