=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760656979
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH MARIE STUMP LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 N. MILLWOOD ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67203-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-265-6011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 N MILLWOOD ST
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67203-5850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-265-6011
-----------------------------------------------------
Fax | 316-265-4022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1033
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------