Healthcare Provider Details

I. General information

NPI: 1477479293
Provider Name (Legal Business Name): MICHELLE RAINE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 N AMIDON AVE STE 224
WICHITA KS
67203-2123
US

IV. Provider business mailing address

1999 N AMIDON AVE STE 224
WICHITA KS
67203-2123
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-4482
  • Fax:
Mailing address:
  • Phone: 316-247-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE RAINE
Title or Position: LICENSED CLINICAL PSYCHOTHERAPIST
Credential: LCP
Phone: 316-247-4482