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General NPI Number Information
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NPI Number | 1619872819
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Entity Type | Organization
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Legal Business Name | GROW WILD THERAPY
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 8100 E 22ND ST N STE D
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City | WICHITA
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State | KS
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Zip | 67226-2350
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Country | US
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Telephone | 316-634-4153
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N BELMONT AVE
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City | WICHITA
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State | KS
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Zip | 67208-3810
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Country | US
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Telephone | 316-203-0741
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA LEIGH MARVIN
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Credential | PHD
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Telephone | 316-204-0741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | NULL
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