Provider Demographics
NPI:1053431676
Name:THE MIRROR, INC.
Entity type:Organization
Organization Name:THE MIRROR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF UTILIZATION
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-400-6863
Mailing Address - Street 1:130 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2206
Mailing Address - Country:US
Mailing Address - Phone:316-283-6743
Mailing Address - Fax:316-283-6830
Practice Address - Street 1:130 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2206
Practice Address - Country:US
Practice Address - Phone:316-283-6743
Practice Address - Fax:316-283-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0093251S00000X, 261QM0801X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014938OtherBCBS OUTPATIENT
KS100106710BMedicaid
KS100106710QMedicaid
KS100106710CMedicaid
KS100106710LMedicaid
KS100106710RMedicaid
KS001402OtherBCBS DAY TREATMENT
KS100106710DMedicaid
KS100106710SMedicaid
KS100106710TMedicaid
KS100106710FMedicaid
KS100106710PMedicaid
KS200676050AMedicaid
KS100106710IMedicaid
KS100106710MMedicaid