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General NPI Number Information
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NPI Number | 1285902676
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Entity Type | Organization
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Legal Business Name | INSIGHT COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 4618 E CENTRAL AVE STE 30
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City | WICHITA
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State | KS
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Zip | 67208-3956
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Country | US
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Telephone | 316-440-4804
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Fax | 316-440-4814
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Provider Business Mailing Address
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Address Line | 4618 E CENTRAL AVE STE 30
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City | WICHITA
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State | KS
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Zip | 67208-3956
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Country | US
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Telephone | 316-440-4804
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Fax | 316-440-4814
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MS. CARLA JO WADE
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Credential | LCAC, LMLP
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Telephone | 316-409-2960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 07400971
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License Number State | KS
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