Provider Demographics
NPI:1407252851
Name:EMILY J. RUNYAN LCP, LLC
Entity Type:Organization
Organization Name:EMILY J. RUNYAN LCP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:RUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCP
Authorized Official - Phone:316-208-4700
Mailing Address - Street 1:4601 E DOUGLAS AVE
Mailing Address - Street 2:OFFICE 128
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1031
Mailing Address - Country:US
Mailing Address - Phone:316-337-5530
Mailing Address - Fax:
Practice Address - Street 1:4601 E DOUGLAS AVE
Practice Address - Street 2:OFFICE 128
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1031
Practice Address - Country:US
Practice Address - Phone:316-337-5530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1448103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200621080BMedicaid