Healthcare Provider Details

I. General information

NPI: 1649151507
Provider Name (Legal Business Name): NINA KHONSAYTHIDET LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N MAIN ST
WICHITA KS
67203-3602
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 316-660-7500
  • Fax:
Mailing address:
  • Phone: 316-666-0760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number05142
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: