Provider Demographics
NPI:1588646087
Name:EWERT, MARLENE R (LMFT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:R
Last Name:EWERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MAIN ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2226
Mailing Address - Country:US
Mailing Address - Phone:316-805-7240
Mailing Address - Fax:
Practice Address - Street 1:414 N MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2226
Practice Address - Country:US
Practice Address - Phone:316-805-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200436500AMedicaid