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General NPI Number Information
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NPI Number | 1326809427
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Entity Type | Organization
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Legal Business Name | BRENDA S GROW, LCMFT, LLC
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 1900 N AMIDON AVE STE 210
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City | WICHITA
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State | KS
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Zip | 67203-2137
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Country | US
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Telephone | 316-573-7791
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Fax | 316-932-1556
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Provider Business Mailing Address
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Address Line | 1900 N AMIDON AVE STE 210
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City | WICHITA
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State | KS
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Zip | 67203-2137
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Country | US
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Telephone | 316-573-7791
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Fax | 316-932-1556
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA GROW
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Credential | LCMFT
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Telephone | 316-573-7791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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