Provider Demographics
NPI:1003043639
Name:ADDICTIVE BEHAVIORAL CHANGE HEALTH GROUP LLC
Entity type:Organization
Organization Name:ADDICTIVE BEHAVIORAL CHANGE HEALTH GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:GOKO
Authorized Official - Last Name:KAMAU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCAC
Authorized Official - Phone:316-260-3445
Mailing Address - Street 1:9918 E. HARRY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5008
Mailing Address - Country:US
Mailing Address - Phone:316-260-3445
Mailing Address - Fax:316-260-3367
Practice Address - Street 1:9918 E. HARRY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5008
Practice Address - Country:US
Practice Address - Phone:316-260-3445
Practice Address - Fax:316-260-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07080895261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder