Healthcare Provider Details

I. General information

NPI: 1407235450
Provider Name (Legal Business Name): CARIE CAGLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 N MARKET ST
WICHITA KS
67214-3515
US

IV. Provider business mailing address

424 ARBOR ST
MULVANE KS
67110-1812
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6294
  • Fax:
Mailing address:
  • Phone: 918-704-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04785
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number481284001
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: