Organization
SHELLY INGRAM LCMFT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY INGRAM (LCMFT)
(316) 461-7923
Entity
Organization
Contact information
Practice address
6525 E MAINSGATE RD, WICHITA, KS 67226-1062
(316) 461-7923
Mailing address
6525 E MAINSGATE RD, WICHITA, KS 67226-1062
(866) 924-4634
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14074800064
LCMFT
KS
01
—
1508085242
LCMFT
—
05
—
1508085242
—
KS
Enumeration date
02/23/2020
Last updated
03/07/2020
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