Provider Demographics
NPI:1700577905
Name:ALVAREZ, DEBRA RUTH (LAC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RUTH
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S LEONINE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2334
Mailing Address - Country:US
Mailing Address - Phone:316-640-1441
Mailing Address - Fax:
Practice Address - Street 1:3737 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2407
Practice Address - Country:US
Practice Address - Phone:316-941-9948
Practice Address - Fax:316-943-7195
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS68101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)