Provider Demographics
NPI:1285352047
Name:PROCTOR, STEPHANIE (LMFT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LEDERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5256 N HOLDER CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2280
Mailing Address - Country:US
Mailing Address - Phone:469-263-3333
Mailing Address - Fax:
Practice Address - Street 1:250 N ROCK RD STE 225
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2242
Practice Address - Country:US
Practice Address - Phone:316-302-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist