Healthcare Provider Details

I. General information

NPI: 1396102315
Provider Name (Legal Business Name): ICT THERAPY WORKS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N WOODLAWN ST
WICHITA KS
67208-3645
US

IV. Provider business mailing address

545 N WOODLAWN ST
WICHITA KS
67208-3645
US

V. Phone/Fax

Practice location:
  • Phone: 316-260-6889
  • Fax: 316-928-2473
Mailing address:
  • Phone: 316-260-6889
  • Fax: 316-928-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY RACHEL PEARSON
Title or Position: OWNER
Credential: PHD
Phone: 316-260-6889