Provider Demographics
NPI:1497983720
Name:HARRIS, MICHELLE LAYNE (LSCSW, LCAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAYNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LSCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4520
Mailing Address - Country:US
Mailing Address - Phone:316-262-2415
Mailing Address - Fax:316-264-4734
Practice Address - Street 1:527 N GROVE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4520
Practice Address - Country:US
Practice Address - Phone:316-262-2415
Practice Address - Fax:316-262-4734
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS698101YA0400X
KS49511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)