Healthcare Provider Details

I. General information

NPI: 1891550489
Provider Name (Legal Business Name): JEREMY MICHAEL HENNING LPC 04598-T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4013 N RIDGE RD STE 110
WICHITA KS
67205-8859
US

IV. Provider business mailing address

426 E BIGGER ST
HUTCHINSON KS
67501-7705
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6294
  • Fax:
Mailing address:
  • Phone: 228-233-6886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number04598
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: