Provider Demographics
NPI:1811141609
Name:TOVAR, KELCIE LYNN (LCMFT)
Entity type:Individual
Prefix:MRS
First Name:KELCIE
Middle Name:LYNN
Last Name:TOVAR
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W CENTRAL AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-6302
Mailing Address - Country:US
Mailing Address - Phone:316-945-5200
Mailing Address - Fax:316-945-5549
Practice Address - Street 1:6700 W CENTRAL AVE STE 106
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-6302
Practice Address - Country:US
Practice Address - Phone:316-945-5200
Practice Address - Fax:316-945-5549
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200579840BMedicaid