Provider Demographics
NPI:1295282507
Name:MASTERS, ABRIEL AILENE (LAC)
Entity type:Individual
Prefix:
First Name:ABRIEL
Middle Name:AILENE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:AILENE
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:212 N. HILLSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214
Mailing Address - Country:US
Mailing Address - Phone:316-558-3066
Mailing Address - Fax:316-558-3067
Practice Address - Street 1:212 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4935
Practice Address - Country:US
Practice Address - Phone:316-558-3066
Practice Address - Fax:316-558-3067
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)