Basic Information
| Provider Information | |||||||||
| NPI: | 1679785265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 337 N ARMOUR ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672062030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168540112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 560 N EXPOSITION | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162648317 | ||||||||
| FaxNumber: | 3162640347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 781 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.