Provider Demographics
NPI:1942655337
Name:SERENITY PSYCHOLOGICAL SERVICES AND CONSULTING LLC
Entity Type:Organization
Organization Name:SERENITY PSYCHOLOGICAL SERVICES AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:YATES
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-302-1240
Mailing Address - Street 1:1010 DOWNING AVE STE 60
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2461
Mailing Address - Country:US
Mailing Address - Phone:785-621-4417
Mailing Address - Fax:866-473-6903
Practice Address - Street 1:1010 DOWNING AVE STE 60
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2461
Practice Address - Country:US
Practice Address - Phone:785-621-4417
Practice Address - Fax:866-473-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS572101YA0400X
KS2318103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty