Organization
SOUTHEAST KANSAS MENTAL HEALTH CENTER
Active
Other names
Ashley Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA BENNETT (DIRECTOR OF OFFICE OPERATIONS)
(620) 365-5717
Entity
Organization
Contact information
Practice address
1106 S 9TH ST, HUMBOLDT, KS 66748-1934
(620) 473-2241
(620) 473-3334
Mailing address
PO BOX 39, HUMBOLDT, KS 66748-0039
(620) 473-2241
(620) 473-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3000391474
—
KS
Enumeration date
04/11/2022
Last updated
03/20/2026
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