Provider Demographics
NPI:1417472275
Name:REISWIG, LANICE KAY (LPC)
Entity Type:Individual
Prefix:
First Name:LANICE
Middle Name:KAY
Last Name:REISWIG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 N LAKE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1321
Mailing Address - Country:US
Mailing Address - Phone:316-259-0103
Mailing Address - Fax:316-721-0492
Practice Address - Street 1:745 W ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-2000
Practice Address - Country:US
Practice Address - Phone:316-722-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-13
Last Update Date:2017-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional