Basic Information
| Provider Information | |||||||||
| NPI: | 1447422654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | TLMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 114 S LARK LN | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672093401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169930274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24401 W MACARTHUR RD | ||||||||
| Address2: | |||||||||
| City: | GODDARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670528713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167942913 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 03/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | TLMFT 868 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.