Healthcare Provider Details

I. General information

NPI: 1518476589
Provider Name (Legal Business Name): MKC COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 N WOODCHUCK ST STE F
WICHITA KS
67212-3571
US

IV. Provider business mailing address

1307 N COACH HOUSE CT
WICHITA KS
67235-9706
US

V. Phone/Fax

Practice location:
  • Phone: 316-371-7226
  • Fax: 888-527-4437
Mailing address:
  • Phone: 316-371-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4695
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2792
License Number StateKS

VIII. Authorized Official

Name: MARCIA CORDES
Title or Position: OWNER/THERAPIST
Credential: LSCSW, LCP
Phone: 316-371-7226