Countryside Counseling Center, LLC
Organization Active NPI Community/Behavioral Health Agency · Independence, KS
NPI 1104100833 · NPPES record last updated Sep 29, 2011
Key facts
- NPI
- 1104100833
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- License
- 103T00000X (KS)
- Legal business name
- COUNTRYSIDE COUNSELING CENTER, LLC
- Practice address
- 601 Morningside Dr
Independence, KS 67301-1932 - Phone
- (620) 577-4955
- Fax
- (620) 577-4956
- NPI assigned
- Sep 29, 2011
- Organization subpart
- No
Authorized official
- Name
- Ms. Debra Lynn Hastings, LCP, LMLP, LCAC
- Title
- Executive Director
- Phone
- (620) 577-4955
Practitioners 1
-
Debra Lynn Hastings, LCP, LCAC
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 103T00000X | KS | Yes |
Addresses
Primary practice location
601 Morningside Dr
Independence, KS 67301-1932
Mailing address
601 Morningside Dr
Independence, KS 67301-1932
Phone (620) 577-4955
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200432330C | Medicaid | KS |
Other providers in Independence, KS
- Debra M Conrady
- Sandra R Cook
- Kathryn Davenport Cornell
- Janet Foster Cosgrove
- Counseling Services of Kansas, LLC
- Tyler James Cox
- Stewart L. Crow
- Abigail Jayne Cundiff
- Sara Daugherty
- Valerie Davis
All providers in Independence, KS · Community/Behavioral Health Agency in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.