Provider Demographics
NPI:1053517367
Name:MUDALIAR, NARAYAN (MSW)
Entity type:Individual
Prefix:MR
First Name:NARAYAN
Middle Name:
Last Name:MUDALIAR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 E TIMBER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-9226
Mailing Address - Country:US
Mailing Address - Phone:316-393-2954
Mailing Address - Fax:
Practice Address - Street 1:3601 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8129
Practice Address - Country:US
Practice Address - Phone:316-630-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW#04441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical