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General NPI Number Information
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NPI Number | 1215536594
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Entity Type | Individual
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Provider Name | MYRANDA CONLEY LCPC
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Gender | Female
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2118 N TYLER RD. BUILDING B, SUITE 100
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City | WICHITA
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State | KS
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Zip | 67212
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Country | US
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Telephone | 316-800-1118
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Fax | 316-747-8597
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Provider Business Mailing Address
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Address Line | 2118 N TYLER RD BUILDING B, STE 100
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City | WICHITA
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State | KS
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Zip | 67212-4912
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Country | US
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Telephone | 316-800-1118
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Fax | 316-747-8597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 03723
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License Number State | KS
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