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General NPI Number Information
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NPI Number | 1528989175
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Entity Type | Organization
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Legal Business Name | WICHITA SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 362 N SAINT CLAIR AVE
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City | WICHITA
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State | KS
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Zip | 67203-5666
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Country | US
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Telephone | 316-210-7480
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Fax |
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Provider Business Mailing Address
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Address Line | 1674 N MURRAY ST
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City | WICHITA
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State | KS
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Zip | 67212-1040
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Country | US
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Telephone | 316-210-7480
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KARIM O JIBRIL
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Credential | LMSW
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Telephone | 316-210-7480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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