# MEDITELECARE OF KANSAS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083116628
- **Authorized official:** ANDREA GODFREY (CREDENTIALING & ENROLLMENT MANAGER)
- **Authorized official phone:** (860) 398-6441

## Contact information

- **Practice address:** 112 SW 7TH ST STE 3C, TOPEKA, KS 66603-3858
- **Practice address phone:** (860) 788-6404
- **Practice address fax:** (860) 829-0495
- **Mailing address:** PO BOX 1595, MIDDLETOWN, CT 06457-8095
- **Mailing address phone:** (860) 788-6404
- **Mailing address fax:** (860) 829-0495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | Yes |
| 103T00000X | Psychologist | — | — | Yes |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/28/2018
- **Last updated:** 05/05/2025