Healthcare Provider Details

I. General information

NPI: 1679406649
Provider Name (Legal Business Name): TABITHA WINTER LCPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 N CADDY LANE SUITE B
WICHITA KS
67212-3832
US

IV. Provider business mailing address

12020 W 85TH ST N
VALLEY CENTER KS
67147-9113
US

V. Phone/Fax

Practice location:
  • Phone: 316-208-9034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TABITHA WINTER
Title or Position: LICENSED CLINICAL PROFESSIONAL COUN
Credential: LCPC
Phone: 316-208-9034