Organization
DEIDRE MANIS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIDRE MANIS LSCSW, LCAC (CLINICAL SOCIAL WORKER)
(620) 875-9656
Entity
Organization
Contact information
Practice address
7807 E FUNSTON ST, WICHITA, KS 67207-3123
(316) 636-1188
(316) 636-1190
Mailing address
1041 N MEADOW RD, VALLEY CENTER, KS 67147-9400
(620) 875-9656
(316) 636-1190
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
12/08/2020
Last updated
12/08/2020
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