Provider Demographics
NPI:1073769485
Name:SEWELL, DARRIN EDWIN (LMLP)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:EDWIN
Last Name:SEWELL
Suffix:
Gender:M
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2353
Mailing Address - Country:US
Mailing Address - Phone:785-825-0541
Mailing Address - Fax:785-825-0062
Practice Address - Street 1:5097 W CLOUD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-9743
Practice Address - Country:US
Practice Address - Phone:785-825-0563
Practice Address - Fax:785-825-0623
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200567220AMedicaid