Healthcare Provider Details

I. General information

NPI: 1528766045
Provider Name (Legal Business Name): VANESSA Y GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 E HARRY ST
WICHITA KS
67207-5089
US

IV. Provider business mailing address

3336 N FAIRVIEW AVE
WICHITA KS
67204-4544
US

V. Phone/Fax

Practice location:
  • Phone: 316-652-2590
  • Fax:
Mailing address:
  • Phone: 620-339-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04319
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: