Provider Demographics
NPI:1750804597
Name:AGUIAR, KATELYN DANAE (LCP)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:DANAE
Last Name:AGUIAR
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 E CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2555
Mailing Address - Country:US
Mailing Address - Phone:316-202-8036
Mailing Address - Fax:316-347-7932
Practice Address - Street 1:9320 E CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2555
Practice Address - Country:US
Practice Address - Phone:316-202-8036
Practice Address - Fax:316-347-7932
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2832103T00000X
KS01513103T00000X
KS2785103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist