Healthcare Provider Details

I. General information

NPI: 1922380831
Provider Name (Legal Business Name): SARAH J.K. WURTZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 EAST HARRY BUILDING 800
WICHITA KS
67207
US

IV. Provider business mailing address

9415 EAST HARRY BUILDING 800
WICHITA KS
67207
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-6303
  • Fax: 316-686-6764
Mailing address:
  • Phone: 316-686-6303
  • Fax: 316-686-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1110
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: