Healthcare Provider Details

I. General information

NPI: 1497038368
Provider Name (Legal Business Name): AMIE KOPISCHKE STAMBAUGH LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N WOODLAWN ST STE 3105
WICHITA KS
67208-3673
US

IV. Provider business mailing address

1427 N DRY CREEK CT
DERBY KS
67037-2831
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-1821
  • Fax: 316-685-0768
Mailing address:
  • Phone: 316-685-1821
  • Fax: 316-685-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number430
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2258
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: