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NPI Code Detail

MEDICARE: LESLEY RAE SELVIDGE T-LMFT

MEDICARE: LESLEY RAE SELVIDGE T-LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist03762-TKS

General Provider Information

NPI Number : 1073491577
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLEY RAE SELVIDGE T-LMFT
Provider Business Mailing Address
First Line : 1211 S EMPORIA AVE
Second Line :
City : WICHITA
State : KS
Zip : 67211-3211
Country : US
Telephone Number : 316-660-9494
Fax Number :
Provider Business Practice Location Address
First Line : 1211 S EMPORIA AVE
Second Line :
City : WICHITA
State : KS
Zip : 67211-3211
Country : US
Telephone Number : 316-660-9494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2025
Last Update Date : 08/22/2025

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Directions to “ LESLEY RAE SELVIDGE T-LMFT” Practice Location

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