Individual
MOLLY JOHANSEN PETRAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
200 MAINE ST STE A, LAWRENCE, KS 66044-1396
(785) 843-9192
Mailing address
200 MAINE ST STE A, LAWRENCE, KS 66044-1396
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
03179
KS
Other
Enumeration date
07/21/2020
Last updated
02/13/2023
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