Healthcare Provider Details

I. General information

NPI: 1801843966
Provider Name (Legal Business Name): SHANTEL R WESTBROOK LMLP/LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E 2ND ST STE B
WICHITA KS
67202-2504
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7800
  • Fax: 316-941-5060
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-660-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0437
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0181
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: