Provider Demographics
NPI:1962819110
Name:CARRILLO, LAUREN (LCMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S WHITTIER ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-1045
Mailing Address - Country:US
Mailing Address - Phone:316-512-7520
Mailing Address - Fax:888-974-1205
Practice Address - Street 1:111 S WHITTIER ST STE 1500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207
Practice Address - Country:US
Practice Address - Phone:316-512-7520
Practice Address - Fax:888-974-1205
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist