Provider Demographics
NPI:1629535265
Name:KANSAS MENTAL HEALTH MEDICINE LLC
Entity Type:Organization
Organization Name:KANSAS MENTAL HEALTH MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVER
Authorized Official - Middle Name:
Authorized Official - Last Name:KREHBIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-260-8700
Mailing Address - Street 1:6432 E 34TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2537
Mailing Address - Country:US
Mailing Address - Phone:316-260-8700
Mailing Address - Fax:316-201-1071
Practice Address - Street 1:6432 E 34TH ST N STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2537
Practice Address - Country:US
Practice Address - Phone:316-260-8700
Practice Address - Fax:316-201-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health