Individual
MIKETO MICHELLE KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.A., LAC
Contact information
Practice address
2050 WEST 11TH ST., WICHITA, KS 67203
(316) 267-5710
Mailing address
1902 E LOOMAN ST, WICHITA, KS 67219-4532
(316) 267-5710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
680
KS
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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