Provider Demographics
NPI:1619032026
Name:GARRISON, CHRISTINA ROSE (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ROSE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ROSE
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-634-3075
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:316-634-3075
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 35891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0201737OtherBCBS
KS0201737Medicare ID - Type Unspecified