Provider Demographics
NPI:1073776910
Name:RAINE, MICHELLE LEA (LCP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEA
Last Name:RAINE
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LEA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCP
Mailing Address - Street 1:437 N TOPEKA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2413
Mailing Address - Country:US
Mailing Address - Phone:316-263-6941
Mailing Address - Fax:316-263-5259
Practice Address - Street 1:439 N MCLEAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5914
Practice Address - Country:US
Practice Address - Phone:316-263-6941
Practice Address - Fax:316-263-5259
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCP 934103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral