Provider Demographics
NPI:1073723623
Name:AVERS, ANITA LOUISE BRADLEY (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LOUISE BRADLEY
Last Name:AVERS
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 E CROWLEY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1426
Mailing Address - Country:US
Mailing Address - Phone:316-734-3589
Mailing Address - Fax:
Practice Address - Street 1:1861 N ROCK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4200
Practice Address - Country:US
Practice Address - Phone:316-688-1790
Practice Address - Fax:316-688-1795
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health