Provider Demographics
NPI:1770871972
Name:BRAGG, ROBERT LOYD (LMFT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOYD
Last Name:BRAGG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 N WOODRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4537
Mailing Address - Country:US
Mailing Address - Phone:316-214-4351
Mailing Address - Fax:
Practice Address - Street 1:2627 N WOODRIDGE CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4537
Practice Address - Country:US
Practice Address - Phone:316-214-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106H00000X
KS2337106H00000X
KST1234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist