Provider Demographics
NPI:1154877603
Name:LANDRUM, ALICIA ROSE (LCPC, LMAC)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ROSE
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:LCPC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1470
Mailing Address - Country:US
Mailing Address - Phone:316-347-7171
Mailing Address - Fax:316-462-0920
Practice Address - Street 1:8406 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1470
Practice Address - Country:US
Practice Address - Phone:316-347-7171
Practice Address - Fax:316-462-0920
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS073101YA0400X
KS2985101YP2500X
KS2700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201143180AMedicaid