Provider Demographics
NPI:1376854414
Name:AST, DEBORAH DIANE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DIANE
Last Name:AST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 N 119TH ST W
Mailing Address - Street 2:STE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1938
Mailing Address - Country:US
Mailing Address - Phone:316-773-4600
Mailing Address - Fax:
Practice Address - Street 1:716 N 119TH ST W
Practice Address - Street 2:STE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-1938
Practice Address - Country:US
Practice Address - Phone:316-773-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1136106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist