Individual
URIAH CTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LMFT
Contact information
Practice address
801 E. DOUGLAS AVENUE, 2ND FLOOR #694, WICHITA, KS 67202
(213) 513-5533
(323) 480-4051
Mailing address
801 E. DOUGLAS AVENUE, 2ND FLOOR #694, WICHITA, KS 67202
(213) 513-5553
(323) 480-4051
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
03112
KS
106H00000X
Marriage & Family Therapist
Primary
121606
CA
106H00000X
Marriage & Family Therapist
205685
TX
Other
Enumeration date
03/14/2016
Last updated
04/03/2025
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