Provider Demographics
NPI:1306192562
Name:GROW, BRENDA S (LCMFT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:GROW
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 1:1900 N AMIDON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2137
Mailing Address - Country:US
Mailing Address - Phone:316-530-1957
Mailing Address - Fax:316-932-1556
Practice Address - Street 1:1900 N AMIDON AVE STE 210
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2137
Practice Address - Country:US
Practice Address - Phone:316-530-1957
Practice Address - Fax:316-932-1556
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2798106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist