| Southeast Kansas Mental Health Center | |
|
1106 S 9th St Humboldt KS 66748-1934 | |
| (620) 473-2241 | |
| (620) 473-3334 |
| Full Name | Southeast Kansas Mental Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1106 S 9th St, Humboldt, Kansas |
| Authorized Official Name and Position | Robert F. Chase (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6203658641 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Kansas Mental Health Center 1106 S 9th St P.o. Box 39 Humboldt KS 66748-1934 Ph: (620) 473-2241 | Southeast Kansas Mental Health Center 1106 S 9th St Humboldt KS 66748-1934 Ph: (620) 473-2241 |
| NPI Number | 1467414771 |
|---|---|
| Provider Enumeration Date | 04/03/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3870562879 |
|---|---|
| Medicare Enrollment ID | O20040927001008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467414771 | NPI | - | NPPES |
| 006901 | Other | KS | BLUE SHIELD |
| 100098050A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 025 (Kansas) | Primary |
| Provider Name | Basuviah Shanker |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821055534 PECOS PAC ID: 7315844230 Enrollment ID: I20031217000954 |
| Provider Name | Timothy C Spears |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639173156 PECOS PAC ID: 5597673327 Enrollment ID: I20040220000487 |
| Provider Name | Pamela R Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740381813 PECOS PAC ID: 3870565724 Enrollment ID: I20040811000433 |
| Provider Name | Guillermo R Ibarra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265497424 PECOS PAC ID: 3173560828 Enrollment ID: I20050413001113 |
| Provider Name | John A Helton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407908023 PECOS PAC ID: 4789628876 Enrollment ID: I20050620000662 |
| Provider Name | Kathryn K Newman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841381894 PECOS PAC ID: 3577631498 Enrollment ID: I20081006000310 |
| Provider Name | Elizabeth D Garton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306037429 PECOS PAC ID: 8628146545 Enrollment ID: I20081006000340 |
| Provider Name | Lila M Peckham Wichman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366409427 PECOS PAC ID: 3375669112 Enrollment ID: I20100929000534 |
| Provider Name | Antigone M Means |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033261664 PECOS PAC ID: 4082730825 Enrollment ID: I20100929000560 |
| Provider Name | Amy A White Blakesley |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588716963 PECOS PAC ID: 2567588304 Enrollment ID: I20100929000662 |
| Provider Name | Douglas E Wright |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083766307 PECOS PAC ID: 8729104575 Enrollment ID: I20100929000693 |
| Provider Name | Janalin Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144372764 PECOS PAC ID: 1658504998 Enrollment ID: I20140512001404 |
| Provider Name | Jason R Gardner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508121294 PECOS PAC ID: 7517286172 Enrollment ID: I20150501001547 |
| Provider Name | Randall Edward Tindle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609368075 PECOS PAC ID: 0345590725 Enrollment ID: I20180905002849 |
| Provider Name | Matthew Leroy |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1326453879 PECOS PAC ID: 1052536034 Enrollment ID: I20200722001804 |
| Provider Name | Michelle A Hoag |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285912675 PECOS PAC ID: 7618380932 Enrollment ID: I20210106000687 |
| Provider Name | Courtney H Mcclendon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962098384 PECOS PAC ID: 8628485299 Enrollment ID: I20210326000129 |
| Provider Name | Kristi Lickteig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437770559 PECOS PAC ID: 9537552211 Enrollment ID: I20220201000694 |
| Provider Name | Sarah D Lange |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629332978 PECOS PAC ID: 0547654923 Enrollment ID: I20220301000727 |
| Provider Name | Megan K Byram |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386133130 PECOS PAC ID: 1850779208 Enrollment ID: I20220526000467 |
| Provider Name | Daniel J Ortiz |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1144857855 PECOS PAC ID: 5890119028 Enrollment ID: I20230510001690 |
| Provider Name | Cheryl Headley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306542824 PECOS PAC ID: 8527424654 Enrollment ID: I20230516002507 |
| Provider Name | Macole J Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073224630 PECOS PAC ID: 7113384421 Enrollment ID: I20230601000241 |
| Provider Name | Debora Higginbotham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578822243 PECOS PAC ID: 1759741309 Enrollment ID: I20230714001726 |
| Provider Name | Rachel Reis Da Silva |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215290614 PECOS PAC ID: 1759743305 Enrollment ID: I20230814001540 |
Southeast Kansas Mental Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1106 S 9th St, Humboldt, KS 66748 Phone: 620-473-2241 Fax: 620-473-3334 | |
Southeast Kansas Mental Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1106 S 9th St, Humboldt, KS 66748 Phone: 620-473-2241 Fax: 620-473-3334 | |
Southeast Kansas Mental Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1106 S 9th St, Humboldt, KS 66748 Phone: 620-473-2241 Fax: 620-473-3334 |