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General NPI Number Information
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NPI Number | 1508728593
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Entity Type | Individual
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Provider Name | JANNY MARTINEZ CARRILLO
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Gender | Male
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Dates
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Enumeration Date | 11/27/2025
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Last Update Date | 11/27/2025
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Provider Practice Location Address
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Address Line | 555 N WOODLAWN ST STE 3105
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City | WICHITA
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State | KS
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Zip | 67208-3673
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Country | US
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Telephone | 316-685-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 630 S TRIG ST
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City | WICHITA
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State | KS
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Zip | 67207-2512
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Country | US
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Telephone |
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Fax |
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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 | 05101-T
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License Number State | KS
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