Provider Demographics
NPI:1437144573
Name:SPETH, PAMELA (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SPETH
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RIVERVIEW ST
Mailing Address - Street 2:SUITE LL2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4200
Mailing Address - Country:US
Mailing Address - Phone:316-363-5253
Mailing Address - Fax:316-262-7202
Practice Address - Street 1:345 RIVERVIEW ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:316-363-5253
Practice Address - Fax:316-262-7202
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS254106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS024437OtherVMC
KS383501OtherBCBS
KS2104873OtherCIGNA BEHAVIORAL HEALTH