Healthcare Provider Details

I. General information

NPI: 1144701194
Provider Name (Legal Business Name): ANA LIZA SCULLY-SKINNER LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N RIDGE RD STE 204
WICHITA KS
67212-6389
US

IV. Provider business mailing address

PO BOX 313
AUGUSTA KS
67010-0313
US

V. Phone/Fax

Practice location:
  • Phone: 316-409-0565
  • Fax: 858-915-0285
Mailing address:
  • Phone: 316-409-0565
  • Fax: 858-915-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00895
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2988
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: