Healthcare Provider Details

I. General information

NPI: 1538784848
Provider Name (Legal Business Name): LUKE CARTER, LP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E DOUGLAS AVE STE 207
WICHITA KS
67218-1032
US

IV. Provider business mailing address

4601 E DOUGLAS AVE STE 207
WICHITA KS
67218-1032
US

V. Phone/Fax

Practice location:
  • Phone: 316-337-5556
  • Fax: 316-337-5531
Mailing address:
  • Phone: 316-337-5556
  • Fax: 316-337-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DIANA MISKIEWICZ
Title or Position: CREDENTIALING
Credential:
Phone: 316-519-1877