Basic Information
| Provider Information | |||||||||
| NPI: | 1154552750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORUETA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | M.S., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2616 E MANTANE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672193063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168310381 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST | ||||||||
| Address2: | STE 102 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166522590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2009 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1063 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.