Provider Demographics
NPI:1346209269
Name:POSSETT, MARILYN S (LSCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:S
Last Name:POSSETT
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S HOLLAND ST
Mailing Address - Street 2:401
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2096
Mailing Address - Country:US
Mailing Address - Phone:316-729-9965
Mailing Address - Fax:
Practice Address - Street 1:520 S HOLLAND ST
Practice Address - Street 2:401
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2096
Practice Address - Country:US
Practice Address - Phone:316-729-9965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22251041C0700X
KS39131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2072809OtherCIGNA BEHAVIORAL HEALTH
OKS50158Medicare UPIN