Provider Demographics
NPI:1871172429
Name:CCF MENTAL HEALTH CONSULTATION PA
Entity type:Organization
Organization Name:CCF MENTAL HEALTH CONSULTATION PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:FULFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW, LCAC
Authorized Official - Phone:316-258-2409
Mailing Address - Street 1:2022 S WEBB RD STE 261
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5627
Mailing Address - Country:US
Mailing Address - Phone:316-258-2409
Mailing Address - Fax:316-285-0527
Practice Address - Street 1:9415 E HARRY ST STE 305
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5077
Practice Address - Country:US
Practice Address - Phone:316-258-2409
Practice Address - Fax:316-285-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty