Provider Demographics
NPI:1619275575
Name:AYRES, DESHA DIANNE (LMFT, AAPS)
Entity Type:Individual
Prefix:MRS
First Name:DESHA
Middle Name:DIANNE
Last Name:AYRES
Suffix:
Gender:F
Credentials:LMFT, AAPS
Other - Prefix:MS
Other - First Name:DESHA
Other - Middle Name:DIANNE
Other - Last Name:DESBIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AAPS
Mailing Address - Street 1:4505 EAST 4TH STREET SOUTH
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67210-1651
Mailing Address - Country:US
Mailing Address - Phone:316-529-9100
Mailing Address - Fax:316-529-9351
Practice Address - Street 1:900 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2037
Practice Address - Country:US
Practice Address - Phone:316-283-1950
Practice Address - Fax:316-283-9540
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist