MEDICARE: EMILY LYNN LPC TEMP

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
1	101YP2500X	Professional Counselor	03972	KS

General Provider Information

NPI Number	:	1710646740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LYNN LPC TEMP

Provider Business Mailing Address
First Line	:	PO BOX 313
Second Line	:
City	:	AUGUSTA
State	:	KS
Zip	:	67010-0313
Country	:	US
Telephone Number	:	316-660-7600
Fax Number	:	855-915-0285

Provider Business Practice Location Address
First Line	:	515 N RIDGE RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-6389
Country	:	US
Telephone Number	:	316-409-0565
Fax Number	:	855-915-0285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	12/11/2025

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