Provider Demographics
NPI:1932299815
Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Other - Org Name:CATHOLIC COMMUNITY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-433-2102
Mailing Address - Street 1:9740 W 87TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4563
Mailing Address - Country:US
Mailing Address - Phone:913-621-5090
Mailing Address - Fax:913-342-1472
Practice Address - Street 1:9700 W. 87TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4563
Practice Address - Country:US
Practice Address - Phone:913-262-1160
Practice Address - Fax:913-262-0818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF NORTHEAST KANSAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-13
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH220000Medicare PIN