Provider Demographics
NPI:1396318341
Name:FORTNEY, RACHEL MARIE (LSCSW, LAC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:FORTNEY
Suffix:
Gender:F
Credentials:LSCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 N AMIDON AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2123
Mailing Address - Country:US
Mailing Address - Phone:316-250-5055
Mailing Address - Fax:866-316-4467
Practice Address - Street 1:1919 N AMIDON AVE STE 317
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2120
Practice Address - Country:US
Practice Address - Phone:316-250-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS109101YA0400X
KS067151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)