Individual
MARYANNE LILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
11828 W CENTRAL AVE STE 104, WICHITA, KS 67212-5178
(316) 613-3995
Mailing address
11828 W CENTRAL AVE STE 104, WICHITA, KS 67212-5178
(316) 613-3995
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC0445
KS
101YM0800X
Mental Health Counselor
LPC0445
KS
101YP2500X
Professional Counselor
Primary
LPC0445
KS
Other
Enumeration date
12/18/2023
Last updated
12/19/2023
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