Provider Demographics
NPI:1558714261
Name:ELISH, KATIE (LMLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ELISH
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 FAIRMOUNT ST
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67260-0034
Mailing Address - Country:US
Mailing Address - Phone:316-978-6180
Mailing Address - Fax:316-978-3086
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5010
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6383
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2701103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral