Healthcare Provider Details

I. General information

NPI: 1093626814
Provider Name (Legal Business Name): HEATHER LOUISE DESPAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 E 39TH CT N
WICHITA KS
67226-2430
US

IV. Provider business mailing address

7015 E 39TH CT N
WICHITA KS
67226-2430
US

V. Phone/Fax

Practice location:
  • Phone: 316-644-4932
  • Fax:
Mailing address:
  • Phone: 316-644-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT03865
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: