Provider Demographics
NPI:1487846564
Name:DRISKILL, AMY JO (MS, LCMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:DRISKILL
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 1:145 S BREEZY POINTE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1415
Mailing Address - Country:US
Mailing Address - Phone:316-749-2007
Mailing Address - Fax:316-943-5554
Practice Address - Street 1:4425 W ZOO BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1620
Practice Address - Country:US
Practice Address - Phone:316-749-2007
Practice Address - Fax:316-749-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS735106H00000X
KSLCMFT 735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200443380EMedicaid