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Organization

HERITAGE MENTAL HEALTH CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DORA CLARK (BILLING MANAGER)
(785) 272-5566
Entity
Organization

Contact information

Practice address
2110 SW BELLE AVE STE B, TOPEKA, KS 66614-1773
(785) 272-5566
(785) 272-5967
Mailing address
2110 SW BELLE AVE STE B, TOPEKA, KS 66614-1773
(785) 272-5566
(785) 272-5967

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
311
KS
1041C0700X
Clinical Social Worker
1366
KS
2084P0800X
Psychiatry Physician
04-20537
KS

Other

Enumeration date
06/21/2005
Last updated
06/24/2020
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