Individual
DAVID J STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSCSW
Contact information
Practice address
940 N WACO AVE, WICHITA, KS 67203-3947
(316) 660-7550
(316) 383-8241
Mailing address
934 N WATER ST, WICHITA, KS 67203-3838
(316) 660-7600
(316) 941-5075
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
5836
KS
1041C0700X
Clinical Social Worker
Primary
053
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
830153
BLUE CROSS BLUE SHIELD
KS
Enumeration date
05/17/2006
Last updated
05/24/2016
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