NPIMap

Organization Active NPI

Avenues for Change

  • Mental Health Counselor
  • Great Bend, KS
National Provider Identifier
1114630076
Registry record updated Apr 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
AVENUES FOR CHANGE
Practice address
809 S Patton Rd
Great Bend, KS 67530-4620
Phone
(620) 796-2206
Fax
(866) 288-1782
NPI assigned
Jan 5, 2023
Last updated
Apr 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelley Johnson, LCPC-S, LCACNPI 1639296759
Title
President
Phone
(620) 796-2206

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

809 S Patton Rd
Great Bend, KS 67530-4620

Mailing address

PO Box 1223
Great Bend, KS 67530-1223
Phone (620) 796-2206

Other practice location 1

2029 Vanesta Pl
Manhattan, KS 66503-0447
Phone (620) 796-2206

Other names 1

  • Avenues For Change Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kelley.johnson@a4change.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240905004630 KS Part B Supplier - Clinic/Group Practice 3577003466 Receives reassigned benefits from 13 practitioners
Practice locations: Great Bend, KS; Manhattan, KS; Dodge City, KS

National Provider Directory

National Provider Directory

Locations

2601 Central Ave
Ste LL12
Dodge City, KS 67801
Phone (620) 796-2206

809 S Patton Rd
Great Bend, KS 67530
Phone (620) 796-2206

2029 Vanesta Pl
Ste 2
Manhattan, KS 66503
Phone (620) 796-2206

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713052800000",
    "number": "1114630076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1223",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675301223",
            "telephone_number": "620-796-2206",
            "fax_number": "866-288-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 S PATTON RD",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675304620",
            "telephone_number": "620-796-2206",
            "fax_number": "866-288-1782"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2029 Vanesta Pl",
            "address_purpose": "LOCATION",
            "city": "Manhattan",
            "state": "KS",
            "postal_code": "665030447",
            "country_code": "US",
            "telephone_number": "620-796-2206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVENUES FOR CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2024-04-14",
        "certification_date": "2024-04-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "620-796-2206",
        "authorized_official_credential": "LCPC-S, LCAC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelley.johnson@a4change.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "809 S Patton Rd",
            "city": "Great Bend",
            "state": "KS",
            "country_code": "US",
            "postal_code": "675304620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Avenues For Change",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Avenues For Change",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Great Bend, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.