Provider Demographics
NPI: | 1952987760 |
---|---|
Name: | WEST CENTRAL MENTAL HEALTH CENTER, INC. |
Entity type: | Organization |
Organization Name: | WEST CENTRAL MENTAL HEALTH CENTER, INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MANDY |
Authorized Official - Middle Name: | JO |
Authorized Official - Last Name: | KAISNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 719-275-2351 |
Mailing Address - Street 1: | 3225 INDEPENDENCE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CANON CITY |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81212-9380 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-275-2351 |
Mailing Address - Fax: | 719-269-9386 |
Practice Address - Street 1: | 701 S 9TH ST |
Practice Address - Street 2: | |
Practice Address - City: | CANON CITY |
Practice Address - State: | CO |
Practice Address - Zip Code: | 81212-4911 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-275-2351 |
Practice Address - Fax: | 719-269-9386 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-03-22 |
Last Update Date: | 2024-05-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |