Provider Demographics
NPI:1194763680
Name:TRAMMEL, BRENDA L (LCP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:TRAMMEL
Suffix:
Gender:F
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 E CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1937
Mailing Address - Country:US
Mailing Address - Phone:316-993-2715
Mailing Address - Fax:866-316-4467
Practice Address - Street 1:6611 E CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1937
Practice Address - Country:US
Practice Address - Phone:316-993-2715
Practice Address - Fax:866-316-4467
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS392674OtherBLUE CROSS BLUE SHIELD
KS200430940FMedicaid