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General NPI Number Information
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NPI Number | 1770871972
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Entity Type | Individual
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Provider Name | ROBERT LOYD BRAGG LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 11/06/2022
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Provider Practice Location Address
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Address Line | 2627 N WOODRIDGE CT
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City | WICHITA
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State | KS
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Zip | 67226-4537
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Country | US
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Telephone | 316-214-4351
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 N WOODRIDGE CT
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City | WICHITA
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State | KS
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Zip | 67226-4537
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Country | US
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Telephone | 316-214-4351
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2337
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T1234
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License Number State | KS
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