Provider Demographics
NPI:1518750876
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:DIRECTOR OF OFFICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-8641
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-0039
Mailing Address - Country:US
Mailing Address - Phone:620-473-2241
Mailing Address - Fax:
Practice Address - Street 1:109 W BUTLER ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1259
Practice Address - Country:US
Practice Address - Phone:620-625-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty