Provider Demographics
NPI:1457509838
Name:FRY, JAYNE ANN (T-LMFT)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ANN
Last Name:FRY
Suffix:
Gender:F
Credentials:T-LMFT
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 STE LL2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4200
Mailing Address - Country:US
Mailing Address - Phone:316-262-5253
Mailing Address - Fax:316-262-7202
Practice Address - Street 1:345 RIVERVIEW ST STE LL2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:316-262-5253
Practice Address - Fax:316-262-7202
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMFT 987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist