Provider Demographics
NPI:1265870927
Name:LORD, DANIEL ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROSS
Last Name:LORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 W 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4018
Mailing Address - Country:US
Mailing Address - Phone:316-721-1290
Mailing Address - Fax:
Practice Address - Street 1:2100 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3379
Practice Address - Country:US
Practice Address - Phone:316-295-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT 001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist