Basic Information
| Provider Information | |||||||||
| NPI: | 1417431206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AREBALO-REALI | ||||||||
| FirstName: | TAYLOR | ||||||||
| MiddleName: | NICOLE | ||||||||
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| OtherLastName: | AREBALO | ||||||||
| OtherFirstName: | TAYLOR | ||||||||
| OtherMiddleName: | NICOLE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11112 W CENTRAL PARK CT | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672052069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9415 E HARRY ST STE 800 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672075084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166522590 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 09/18/2018 | ||||||||
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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 | 104100000X | 10511 | KS | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.