Provider Demographics
NPI:1700076296
Name:BETTY K. SKINNER, LSCSW, INC.
Entity Type:Organization
Organization Name:BETTY K. SKINNER, LSCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, ACSW
Authorized Official - Phone:316-201-1080
Mailing Address - Street 1:2135 N SUNRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1503
Mailing Address - Country:US
Mailing Address - Phone:316-201-1080
Mailing Address - Fax:316-201-1085
Practice Address - Street 1:2135 N SUNRIDGE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1503
Practice Address - Country:US
Practice Address - Phone:316-201-1080
Practice Address - Fax:316-201-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200003060/CMedicaid
KS200003060/CMedicaid