Provider Demographics
NPI:1881706398
Name:BEHAVIORAL MEDICINE SPECIALISTS, PA
Entity type:Organization
Organization Name:BEHAVIORAL MEDICINE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-686-5195
Mailing Address - Street 1:7829 E ROCKHILL ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3920
Mailing Address - Country:US
Mailing Address - Phone:316-686-5195
Mailing Address - Fax:316-686-8714
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-686-5195
Practice Address - Fax:316-686-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110400Medicare ID - Type Unspecified