| Village Lake | |
|
345 Riverview St. #730 Wichita Ks KS 67203 | |
| (316) 395-2886 | |
| Not Available |
| Full Name | Village Lake |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 345 Riverview St. #730, Ks, Kansas |
| Authorized Official Name and Position | Anaidy G Claudio Rosa (THERAPIST) |
| Authorized Official Contact | 3162847730 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Village Lake 265 W Village Lake Dr Derby KS 67037-2612 Ph: (316) 284-7730 | Village Lake 345 Riverview St. #730 Wichita Ks KS 67203 Ph: (316) 395-2886 |
| NPI Number | 1326897067 |
|---|---|
| Provider Enumeration Date | 05/15/2024 |
| Last Update Date | 12/12/2024 |
| Certification Date | 12/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326897067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |