Provider Demographics
NPI:1891901856
Name:GRAGG, ADAM (LCMFT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GRAGG
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 W BARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-7323
Mailing Address - Country:US
Mailing Address - Phone:316-773-6634
Mailing Address - Fax:316-262-8829
Practice Address - Street 1:1601 E DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1609
Practice Address - Country:US
Practice Address - Phone:316-262-8293
Practice Address - Fax:316-262-8829
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCFMT241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist