Healthcare Provider Details

I. General information

NPI: 1215570197
Provider Name (Legal Business Name): HANNAH PICKERING T-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S BROADWAY AVE
WICHITA KS
67202-4304
US

IV. Provider business mailing address

271 W 3RD ST N STE 600
WICHITA KS
67202-1223
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-9600
  • Fax: 316-660-9660
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-941-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3501
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: