# FAMILY THERAPY INSTITUTE MIDWEST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306872064
- **Authorized official:** MARY LU EGIDY APRN (OWNER)
- **Authorized official phone:** (785) 830-8299

## Contact information

- **Practice address:** 2619 W. 6TH STREET, SUITE C, LAWRENCE, KS 66049
- **Practice address phone:** (785) 830-8299
- **Practice address fax:** (785) 749-2581
- **Mailing address:** 2619 W. 6TH STREET, SUITE C, LAWRENCE, KS 66049
- **Mailing address phone:** (785) 830-8299
- **Mailing address fax:** (785) 749-2581

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 0894 | KS | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 1109 | KS | — |
| 104100000X | Social Worker | 6890 | KS | — |
| 1041C0700X | Clinical Social Worker | 1740 | KS | — |
| 1041C0700X | Clinical Social Worker | 3569 | KS | — |
| 163WP0807X | Child & Adolescent Psychiatric/Mental Health Registered Nurse | 46111 | KS | — |
| 163WP0807X | Child & Adolescent Psychiatric/Mental Health Registered Nurse | 74564 | KS | — |

## Other

- **Enumeration date:** 06/24/2006
- **Last updated:** 11/07/2016