Provider Demographics
NPI:1194152298
Name:WICKELL, ASHER J (LCMFT)
Entity type:Individual
Prefix:MR
First Name:ASHER
Middle Name:J
Last Name:WICKELL
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:ASH
Other - Middle Name:
Other - Last Name:WICKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMFT
Mailing Address - Street 1:9415 E HARRY ST STE 308
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5077
Mailing Address - Country:US
Mailing Address - Phone:316-351-8083
Mailing Address - Fax:888-975-1954
Practice Address - Street 1:9415 E HARRY ST STE 308
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5077
Practice Address - Country:US
Practice Address - Phone:316-351-8083
Practice Address - Fax:888-975-1954
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2509106H00000X
KS2790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201102000AMedicaid