Healthcare Provider Details

I. General information

NPI: 1427004506
Provider Name (Legal Business Name): JEANETTE BELEW LMLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: JEANETTE KELLEY

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N EXPOSITION ST
WICHITA KS
67203-5957
US

IV. Provider business mailing address

560 N EXPOSITION ST
WICHITA KS
67203-5957
US

V. Phone/Fax

Practice location:
  • Phone: 316-264-8317
  • Fax: 316-264-0347
Mailing address:
  • Phone: 316-264-8317
  • Fax: 316-264-0347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number730
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: