Healthcare Provider Details

I. General information

NPI: 1164339925
Provider Name (Legal Business Name): ANGELA BETH BANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W 13TH ST N STE 211
WICHITA KS
67212-2943
US

IV. Provider business mailing address

12542 W HARDTNER ST
WICHITA KS
67235-1332
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-3617
  • Fax:
Mailing address:
  • Phone: 316-461-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: