Healthcare Provider Details

I. General information

NPI: 1245613546
Provider Name (Legal Business Name): SHANNON BRANDES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 N CLARENCE AVE
WICHITA KS
67204-3437
US

IV. Provider business mailing address

4000 N CLARENCE AVE
WICHITA KS
67204-3437
US

V. Phone/Fax

Practice location:
  • Phone: 239-227-8622
  • Fax:
Mailing address:
  • Phone: 239-227-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC03010
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007832-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: