Provider Demographics
NPI:1669830980
Name:CUNNINGHAM, KATE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:
Last Name:CUNNINGHAM
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 1:250 N ROCK RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2261
Mailing Address - Country:US
Mailing Address - Phone:316-530-2813
Mailing Address - Fax:316-613-2667
Practice Address - Street 1:250 N ROCK RD STE 130
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2261
Practice Address - Country:US
Practice Address - Phone:316-530-2813
Practice Address - Fax:316-613-2667
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201121070AMedicaid