Provider Demographics
NPI:1134212608
Name:TOWNSEND, CHARLES H (LSCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:H
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7570 W 21ST ST N BLDG 1046
Mailing Address - Street 2:STE A106
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-942-2723
Mailing Address - Fax:316-260-4414
Practice Address - Street 1:7570 W 21ST ST N BLDG 1046
Practice Address - Street 2:STE A106
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-942-2723
Practice Address - Fax:316-260-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070873Medicare ID - Type Unspecified