Healthcare Provider Details

I. General information

NPI: 1831011006
Provider Name (Legal Business Name): KAITLIN LYNN PHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 E CENTRAL AVE STE 230
WICHITA KS
67206-2369
US

IV. Provider business mailing address

8080 E CENTRAL AVE STE 230
WICHITA KS
67206-2369
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-8118
  • Fax: 316-721-8139
Mailing address:
  • Phone: 316-721-8118
  • Fax: 316-721-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05509
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: