Provider Demographics
NPI:1164907663
Name:GOSNELL, CHRISTA (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:REUSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5535 S DODGE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-6403
Mailing Address - Country:US
Mailing Address - Phone:316-712-0903
Mailing Address - Fax:855-871-5714
Practice Address - Street 1:5535 S DODGE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-6403
Practice Address - Country:US
Practice Address - Phone:316-712-0903
Practice Address - Fax:855-871-5714
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201216140AMedicaid