Healthcare Provider Details

I. General information

NPI: 1689616062
Provider Name (Legal Business Name): CHRISTIAN COUNSELING CENTER OF WICHITA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GREENWOOD ST
WICHITA KS
67211-1844
US

IV. Provider business mailing address

333 GREENWOOD ST
WICHITA KS
67211-1844
US

V. Phone/Fax

Practice location:
  • Phone: 316-264-8800
  • Fax: 316-264-8809
Mailing address:
  • Phone: 316-264-8800
  • Fax: 316-264-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number642
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number643
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2271
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1957
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2526
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number622
License Number StateKS
# 9
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number219
License Number StateKS

VIII. Authorized Official

Name: DR. MARK D. GLOVER
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 316-264-8800