Provider Demographics
NPI:1235910225
Name:MORTENSEN, SYDNEY KERSTEN (LPC)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KERSTEN
Last Name:MORTENSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 N YALE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3242
Mailing Address - Country:US
Mailing Address - Phone:913-378-5029
Mailing Address - Fax:
Practice Address - Street 1:338 N YALE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3242
Practice Address - Country:US
Practice Address - Phone:913-378-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health