Healthcare Provider Details

I. General information

NPI: 1205757507
Provider Name (Legal Business Name): GLENDON THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 E MAINSGATE RD
WICHITA KS
67226-1062
US

IV. Provider business mailing address

4927 E 101ST ST N
VALLEY CENTER KS
67147-8739
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-7923
  • Fax:
Mailing address:
  • Phone: 316-200-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05471
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: