Provider Demographics
NPI:1992846752
Name:SOUTHEAST KANSAS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEAST KANSAS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-8641
Mailing Address - Street 1:1106 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1934
Mailing Address - Country:US
Mailing Address - Phone:620-473-2241
Mailing Address - Fax:620-473-3334
Practice Address - Street 1:1106 S 9TH ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:KS
Practice Address - Zip Code:66748-1934
Practice Address - Country:US
Practice Address - Phone:620-473-2241
Practice Address - Fax:620-473-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS025261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS006901OtherBLUE SHIELD
KS006901Medicare ID - Type Unspecified