Healthcare Provider Details

I. General information

NPI: 1659631620
Provider Name (Legal Business Name): KAREN ELAINE SUTTON LMSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 W MAY ST
WICHITA KS
67213-3505
US

IV. Provider business mailing address

1050 N LIGHTNER ST
WICHITA KS
67208-2747
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-0505
  • Fax:
Mailing address:
  • Phone: 316-295-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number944
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8348
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: