Provider Demographics
NPI:1841406055
Name:BROWN, CHERELLE D (MS, LCMFT, LMAC)
Entity Type:Individual
Prefix:
First Name:CHERELLE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, LCMFT, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 W CENTRAL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5187
Mailing Address - Country:US
Mailing Address - Phone:316-670-9895
Mailing Address - Fax:316-928-4986
Practice Address - Street 1:11828 W CENTRAL
Practice Address - Street 2:SUITE 104
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5178
Practice Address - Country:US
Practice Address - Phone:316-670-9895
Practice Address - Fax:316-928-4986
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMAC176101YA0400X
KSLCMFT885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201085710AMedicaid