Provider Demographics
NPI:1407112477
Name:DOBRATZ, CINDY LOU (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LOU
Last Name:DOBRATZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-269-2322
Mailing Address - Fax:316-269-2448
Practice Address - Street 1:210 SOULE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2558
Practice Address - Country:US
Practice Address - Phone:260-227-2503
Practice Address - Fax:260-227-9905
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS888101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)