Provider Demographics
NPI:1952627374
Name:MASTERS, CONNIE S (LMFT, LCAC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:S
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LMFT, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1319
Mailing Address - Country:US
Mailing Address - Phone:316-777-4246
Mailing Address - Fax:316-260-2049
Practice Address - Street 1:715 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1319
Practice Address - Country:US
Practice Address - Phone:316-777-4246
Practice Address - Fax:316-260-2049
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT 1014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist