Healthcare Provider Details

I. General information

NPI: 1114838133
Provider Name (Legal Business Name): EMMA LEA ETANA RUST LMFT-T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 E ORME ST STE A
WICHITA KS
67207-2424
US

IV. Provider business mailing address

8911 E ORME ST STE A
WICHITA KS
67207-2424
US

V. Phone/Fax

Practice location:
  • Phone: 316-425-7774
  • Fax: 316-425-7779
Mailing address:
  • Phone: 316-358-8014
  • Fax: 316-425-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number03903-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: