Organization
CHANGING HABITS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID BRIAN SIMMONS LAC (OWNER)
(316) 409-5242
Entity
Organization
Contact information
Practice address
1115 S GLENDALE ST STE 204, PARKLANE SHOPPING CENTER LOWER LEVEL, WICHITA, KS 67218-3232
(316) 409-5242
(316) 719-2440
Mailing address
1115 S GLENDALE ST STE 204, PARKLANE SHOPPING CENTER LOWER LEVEL, WICHITA, KS 67218-3232
(316) 409-5242
(316) 719-2440
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
07570128
KS
Other
Enumeration date
02/21/2013
Last updated
12/22/2015
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