Provider Demographics
NPI:1740615194
Name:MEYERHOFFER-KUBALIK, EMILY (TLMLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MEYERHOFFER-KUBALIK
Suffix:
Gender:F
Credentials:TLMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-660-7510
Practice Address - Street 1:7701 E KELLOGG DR
Practice Address - Street 2:STE 300
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-1706
Practice Address - Country:US
Practice Address - Phone:316-660-9600
Practice Address - Fax:316-660-9660
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2498103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling