Provider Demographics
NPI:1306820444
Name:RUMBACK, KRISTA L (LCP, LMLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:RUMBACK
Suffix:
Gender:F
Credentials:LCP, LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E 1ST ST; PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6490
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:SUITE 1026D
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1764
Practice Address - Country:US
Practice Address - Phone:316-729-6555
Practice Address - Fax:316-634-4794
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0447103TB0200X
KS220103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral