Provider Demographics
NPI:1518414002
Name:SMOTHERMON, WESLEY SCOTT (TLMFT, CPT)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:SCOTT
Last Name:SMOTHERMON
Suffix:
Gender:M
Credentials:TLMFT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 W. 21ST ST. N BUILDING 1042 SUITE B
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-239-1880
Mailing Address - Fax:
Practice Address - Street 1:8080 E CENTRAL AVE # 190
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2368
Practice Address - Country:US
Practice Address - Phone:316-302-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty