Provider Demographics
NPI:1841402203
Name:CHAUTAUQUA COUNSELING CENER, INC.
Entity Type:Organization
Organization Name:CHAUTAUQUA COUNSELING CENER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLTGREWE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:913-645-6652
Mailing Address - Street 1:5960 DEARBORN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3316
Mailing Address - Country:US
Mailing Address - Phone:913-362-6614
Mailing Address - Fax:913-362-6614
Practice Address - Street 1:5960 DEARBORN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3316
Practice Address - Country:US
Practice Address - Phone:913-362-6614
Practice Address - Fax:913-362-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS530251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32788013OtherBLUE CROSS BLUE SHIELD