Provider Demographics
NPI:1972603900
Name:CEDAR BRANCH RECOVERY SYSTEMS, PA
Entity Type:Organization
Organization Name:CEDAR BRANCH RECOVERY SYSTEMS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:VIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-840-0374
Mailing Address - Street 1:1113 PRESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3686
Mailing Address - Country:US
Mailing Address - Phone:785-840-0374
Mailing Address - Fax:785-856-2301
Practice Address - Street 1:719 MASSACHUSETTS ST
Practice Address - Street 2:SUITE 118
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2345
Practice Address - Country:US
Practice Address - Phone:785-840-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 1804101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty