Healthcare Provider Details

I. General information

NPI: 1710646740
Provider Name (Legal Business Name): EMILY LYNN LPC TEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N RIDGE RD
WICHITA KS
67212-6389
US

IV. Provider business mailing address

PO BOX 313
AUGUSTA KS
67010-0313
US

V. Phone/Fax

Practice location:
  • Phone: 316-409-0565
  • Fax: 855-915-0285
Mailing address:
  • Phone: 316-660-7600
  • Fax: 855-915-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03972
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: