Provider Demographics
NPI:1679642318
Name:CENTRAL KANSAS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CENTRAL KANSAS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KOHRS
Authorized Official - Suffix:
Authorized Official - Credentials:PHF
Authorized Official - Phone:620-792-6619
Mailing Address - Street 1:2335 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:KS
Mailing Address - Zip Code:67444-9017
Mailing Address - Country:US
Mailing Address - Phone:620-792-6619
Mailing Address - Fax:620-792-2136
Practice Address - Street 1:925 S PATTON RD
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4627
Practice Address - Country:US
Practice Address - Phone:620-792-6619
Practice Address - Fax:620-792-2136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS004515Medicare ID - Type Unspecified