Healthcare Provider Details

I. General information

NPI: 1831131689
Provider Name (Legal Business Name): ALISYN EDWARDS LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 N WATER ST
WICHITA KS
67203-3838
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7525
  • Fax: 316-383-4590
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-383-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0169
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number272
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: