Provider Demographics
NPI:1457661654
Name:JEFFRIES, IRMA RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:RAE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 E DOUGLAS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1031
Mailing Address - Country:US
Mailing Address - Phone:316-992-4978
Mailing Address - Fax:316-337-5531
Practice Address - Street 1:4601 E DOUGLAS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1031
Practice Address - Country:US
Practice Address - Phone:316-992-4978
Practice Address - Fax:316-337-5531
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health