Provider Demographics
NPI:1871095596
Name:BETHANY A. OWENS, LSCSW
Entity type:Organization
Organization Name:BETHANY A. OWENS, LSCSW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAYZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-944-3940
Mailing Address - Street 1:PO BOX 17053
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-0053
Mailing Address - Country:US
Mailing Address - Phone:316-944-3940
Mailing Address - Fax:316-946-0694
Practice Address - Street 1:400 N WOODLAWN ST STE 30
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4333
Practice Address - Country:US
Practice Address - Phone:316-612-9223
Practice Address - Fax:316-612-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS47681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4768OtherSTATE LICENSE
KS201109570BMedicaid