NPIMap

Organization Active NPI

Heritage Mental Health Clinic, LLC

  • Clinical Psychologist
  • Topeka, KS
National Provider Identifier
1487650842
Registry record updated Jun 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
311 Issued in KS
Legal business name
HERITAGE MENTAL HEALTH CLINIC, LLC
Practice address
2110 SW Belle Ave Ste B
Topeka, KS 66614-1773
Phone
(785) 272-5566
Fax
(785) 272-5967
NPI assigned
Jun 21, 2005
Last updated
Jun 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2020

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

Authorized official

Name
Dora Clark
Title
Billing Manager
Phone
(785) 272-5566

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 311 KS Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 1366 KS
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 04-20537 KS

Addresses

Primary practice location

2110 SW Belle Ave Ste B
Topeka, KS 66614-1773

Mailing address

2110 SW Belle Ave Ste B
Topeka, KS 66614-1773
Phone (785) 272-5566

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040924000162 KS Part B Supplier - Clinic/Group Practice 6901874148 Receives reassigned benefits from 6 practitioners
Practice locations: Topeka, KS

National Provider Directory

National Provider Directory

Locations

2100 SW Belle Ave
Ste B
Topeka, KS 66614

2110 SW Belle Ave
Topeka, KS 66614
Phone (785) 272-5566

2955 SW Wanamaker Dr
Topeka, KS 66614
Phone (785) 231-8366

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592956800000",
    "number": "1487650842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 SW BELLE AVE STE B",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666141773",
            "telephone_number": "785-272-5566",
            "fax_number": "785-272-5967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 SW BELLE AVE STE B",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666141773",
            "telephone_number": "785-272-5566",
            "fax_number": "785-272-5967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE MENTAL HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DORA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "785-272-5566"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "311",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "KS",
            "license": "1366",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KS",
            "license": "04-20537",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Topeka, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; 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.