Provider Demographics
NPI:1801843966
Name:WESTBROOK, SHANTEL R (LMLP/LCP)
Entity Type:Individual
Prefix:MS
First Name:SHANTEL
Middle Name:R
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:LMLP/LCP
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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 1:402 E 2ND ST
Practice Address - Street 2:STE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2504
Practice Address - Country:US
Practice Address - Phone:316-660-7800
Practice Address - Fax:316-941-5060
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0437103TC0700X
KS0181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4204OtherPREFERRED HEALTH SYSTEMS
KS392666OtherBLUE CROSS BLUE SHIELD
KS2153197OtherCIGNA