Provider Demographics
NPI:1871909424
Name:MENTAL HEALTH COLLECTIVE, LLC
Entity type:Organization
Organization Name:MENTAL HEALTH COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-841-5555
Mailing Address - Street 1:4321 W 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3607
Mailing Address - Country:US
Mailing Address - Phone:785-841-5555
Mailing Address - Fax:785-841-8781
Practice Address - Street 1:4321 W 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3607
Practice Address - Country:US
Practice Address - Phone:785-841-5555
Practice Address - Fax:785-841-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04232232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE64543Medicare UPIN