Basic Information
| Provider Information | |||||||||
| NPI: | 1639104599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILE | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LCMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FRY | ||||||||
| OtherFirstName: | ERICA | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 560 N. EXPOSITION | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164618317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 N. EXPOSITION | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3164618317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 501 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.