Provider Demographics
NPI:1760159925
Name:BURNS, ASHLY PAIGE
Entity Type:Individual
Prefix:
First Name:ASHLY
Middle Name:PAIGE
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:PAIGE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6525 E MAINSGATE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1062
Mailing Address - Country:US
Mailing Address - Phone:316-461-7923
Mailing Address - Fax:316-260-7045
Practice Address - Street 1:6525 E MAINSGATE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1062
Practice Address - Country:US
Practice Address - Phone:316-461-7923
Practice Address - Fax:316-260-7045
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03295106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist