Healthcare Provider Details

I. General information

NPI: 1619331519
Provider Name (Legal Business Name): FAMILY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 E CENTRAL AVE SUITE C
WICHITA KS
67206-1937
US

IV. Provider business mailing address

6611 E CENTRAL AVE STE C
WICHITA KS
67206-1937
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-4559
  • Fax: 316-358-7713
Mailing address:
  • Phone: 316-260-4559
  • Fax: 316-358-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberLCP-927
License Number StateKS

VIII. Authorized Official

Name: MR. SHAWN PATRICK PADGETT
Title or Position: LICENSED CLINICAL PSYCHOTHERAPIST
Credential: MS, LCP
Phone: 316-691-9711