Organization
SOUTHEAST KANSAS MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA BENNETT (DIRECTOR OF OFFICE OPERATIONS)
(620) 365-8641
Entity
Organization
Contact information
Practice address
1106 S 9TH ST, HUMBOLDT, KS 66748-1934
(620) 473-2241
(620) 473-3334
Mailing address
1106 S 9TH ST, HUMBOLDT, KS 66748-1934
(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
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
025
KS
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006901
BLUE SHIELD
KS
05
—
3000391474
—
KS
Enumeration date
04/03/2006
Last updated
03/20/2026
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