Individual
DR. KENNETH LIEBENAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
727 N WACO AVE, STE 320, WICHITA, KS 67203-3972
(316) 616-0260
(316) 616-0264
Mailing address
727 N WACO AVE, STE 320, WICHITA, KS 67203-3972
(316) 616-0260
(316) 616-0264
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP-1019
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11890
PREFERRED HEALTH SYSTEMS
KS
01
—
119713
BLUE CROSS BLUE SHIELD
KS
Enumeration date
05/23/2005
Last updated
08/29/2007
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