Organization
VILLAGE LAKE
Active
Other names
Village Lake Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
ANAIDY G CLAUDIO ROSA LSCSW, LCAC (THERAPIST)
(316) 284-7730
Entity
Organization
Contact information
Practice address
345 RIVERVIEW ST. #730, WICHITA, KS, KS 67203
(316) 395-2886
Mailing address
265 W VILLAGE LAKE DR, DERBY, KS 67037-2612
(316) 284-7730
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
05/15/2024
Last updated
12/12/2024
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