| Mental Health Specialty Group Ks, P.a. | |
|
801 E Douglas Ave Wichita KS 67202-3548 | |
| (323) 205-7088 | |
| Not Available |
| Full Name | Mental Health Specialty Group Ks, P.a. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 801 E Douglas Ave, Wichita, Kansas |
| Authorized Official Name and Position | Gabriel Diop (AUTHORIZED AGENT) |
| Authorized Official Contact | 3232057088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Specialty Group Ks, P.a. Po Box 745249 Atlanta GA 30374-5249 Ph: (323) 205-7088 | Mental Health Specialty Group Ks, P.a. 801 E Douglas Ave Wichita KS 67202-3548 Ph: (323) 205-7088 |
| NPI Number | 1063282390 |
|---|---|
| Provider Enumeration Date | 01/08/2024 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Medicare PECOS PAC ID | 5991228165 |
|---|---|
| Medicare Enrollment ID | O20250327003774 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063282390 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Calvin Shope |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588068712 PECOS PAC ID: 7315313053 Enrollment ID: I20221020000714 |
| Provider Name | Rachel Arnold |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497361588 PECOS PAC ID: 0648628842 Enrollment ID: I20231129000681 |
| Provider Name | Mary Bauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427006337 PECOS PAC ID: 5799738357 Enrollment ID: I20240712001620 |
| Provider Name | Marisa Murray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720587397 PECOS PAC ID: 0345768875 Enrollment ID: I20250519000526 |
| Provider Name | Thereasa Deniece Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669266540 PECOS PAC ID: 4284143751 Enrollment ID: I20250605000136 |
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