Provider Demographics
NPI:1710646393
Name:LINDA R CRENSHAW LSCSW
Entity Type:Organization
Organization Name:LINDA R CRENSHAW LSCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, RPT
Authorized Official - Phone:316-519-0673
Mailing Address - Street 1:PO BOX 20733
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-6733
Mailing Address - Country:US
Mailing Address - Phone:316-519-0673
Mailing Address - Fax:
Practice Address - Street 1:AFFINITY MENTAL WELLNESS 7570 W 21ST ST NORTH
Practice Address - Street 2:BUILDING 1046, SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-776-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty