Provider Demographics
NPI:1710855432
Name:PAGE, ALEXANDER KENNEDY
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:KENNEDY
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67220-6604
Mailing Address - Country:US
Mailing Address - Phone:316-290-9853
Mailing Address - Fax:
Practice Address - Street 1:1861 N ROCK RD STE 330
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1264
Practice Address - Country:US
Practice Address - Phone:316-290-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT03733T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist