Basic Information
| Provider Information | |||||||||
| NPI: | 1801843966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTBROOK | ||||||||
| FirstName: | SHANTEL | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMLP/LCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3166607510 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 E 2ND ST | ||||||||
| Address2: | STE B | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672022504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607800 | ||||||||
| FaxNumber: | 3169415060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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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 | 103TC0700X | 0437 | KS | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 0181 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 4204 | 01 | KS | PREFERRED HEALTH SYSTEMS | OTHER | 392666 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER | 2153197 | 01 | KS | CIGNA | OTHER |