Individual
JONATHAN ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
5900 E CENTRAL AVE, SUITE 101, WICHITA, KS 67208-4240
(316) 425-7774
(316) 425-7779
Mailing address
5900 E CENTRAL AVE, SUITE 101, WICHITA, KS 67208-4240
(316) 425-7774
(316) 425-7779
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1049
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200750620A
—
KS
Enumeration date
11/19/2011
Last updated
12/05/2012
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