Basic Information
| Provider Information | |||||||||
| NPI: | 1740309814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N WOODLAWN ST STE.102 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166522590 | ||||||||
| FaxNumber: | 3166522595 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166522590 | ||||||||
| FaxNumber: | 3166522595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 823 | KS | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.