Avenues for Change
Organization Active NPI Mental Health Counselor · Great Bend, KS
NPI 1114630076 · NPPES record last updated Apr 14, 2024
Key facts
- NPI
- 1114630076
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 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
- Organization subpart
- No
Authorized official
- Name
- Kelley Johnson, LCPC-S, LCAC
- Title
- President
- Phone
- (620) 796-2206
Practitioners 19
-
Kelley Lynn Johnson, LCPC-S, LCAC
-
Christie Lynn Kelly, T-LPC
-
Toni Lynne Lovett, LPC
-
Heather Harris, LCPC
-
Linda Henson, LPC
-
Makenzie Hoch, LMSW
-
David Miller, LPC
-
Summer Rhodes, LMSW
-
Marilea Williams, LMFT
-
Jalyn Marie Kizzar, LSCSW
-
Ramona Rhodes, T-LMSW
-
Bailey Schafer, LMSW
-
Amanda Gail Lakin, APRN, PMHNP-BC
-
Karina Nicole Weigel, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes |
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
- Avenues For Change
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kelley.johnson@a4change.org | Direct |
Other providers in Great Bend, KS
- Jenna Kay Anderson
- Jessie Andrasek
- Stephanie Andrasek
- Veerayyagari Annapurna
- Amy C Antle
- Tyler Axman
- Jennifer Ayres
- Kristin Layne Babcock
- Wade Babcock
- June Annette Barger
All providers in Great Bend, KS · Mental Health Counselor in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.