Provider Demographics
NPI:1801991203
Name:SOUTHWEST GUIDANCE CENTER
Entity type:Organization
Organization Name:SOUTHWEST GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:620-624-8171
Mailing Address - Street 1:PO BOX 2945
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-2945
Mailing Address - Country:US
Mailing Address - Phone:620-624-8171
Mailing Address - Fax:620-624-0114
Practice Address - Street 1:333 W 15TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-8171
Practice Address - Fax:620-624-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098060AMedicaid
KS100098060BMedicaid
KS006915Medicare ID - Type UnspecifiedAGENCY PROVIDER NUMBER