Healthcare Provider Details

I. General information

NPI: 1043811821
Provider Name (Legal Business Name): JENAE LLAMAS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 04/21/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 N MAIZE CT STE 100
WICHITA KS
67205-7358
US

IV. Provider business mailing address

2544 N MAIZE CT STE 100
WICHITA KS
67205-7358
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6047
  • Fax:
Mailing address:
  • Phone: 316-201-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03250
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: