Organization
COUNTRYSIDE COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA LYNN HASTINGS LCP, LMLP, LCAC (EXECUTIVE DIRECTOR)
(620) 577-4955
Entity
Organization
Contact information
Practice address
601 MORNINGSIDE DR, INDEPENDENCE, KS 67301-1932
(620) 577-4955
(620) 577-4956
Mailing address
601 MORNINGSIDE DR, INDEPENDENCE, KS 67301-1932
(620) 577-4955
(620) 577-4956
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
103T00000X
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432330C
—
KS
Enumeration date
09/29/2011
Last updated
09/29/2011
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