Healthcare Provider Details

I. General information

NPI: 1265740088
Provider Name (Legal Business Name): HELEN CHRISTINA GRZESKIEWICZ LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA GRZESKIEWICZ LCP, LCAC

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 N WOODLAWN BLVD BLDG 300
WICHITA KS
67220-3960
US

IV. Provider business mailing address

2420 N WOODLAWN BLVD STE 300
WICHITA KS
67220-3960
US

V. Phone/Fax

Practice location:
  • Phone: 316-347-7157
  • Fax: 316-247-9528
Mailing address:
  • Phone: 316-347-7157
  • Fax: 316-247-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1497
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: