Provider Demographics
NPI:1780866277
Name:DRINKWATER, KELLIE CHRISTINE (T-LPC)
Entity Type:Individual
Prefix:MISS
First Name:KELLIE
Middle Name:CHRISTINE
Last Name:DRINKWATER
Suffix:
Gender:F
Credentials:T-LPC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:CHRISTINE
Other - Last Name:BRUNSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10206 W LYDIA CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3072
Mailing Address - Country:US
Mailing Address - Phone:316-469-9452
Mailing Address - Fax:
Practice Address - Street 1:4510 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2203
Practice Address - Country:US
Practice Address - Phone:316-440-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional