Provider Demographics
NPI:1396253902
Name:CHALFANT, AUBONY RAE (LPC)
Entity type:Individual
Prefix:
First Name:AUBONY
Middle Name:RAE
Last Name:CHALFANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64124-1709
Mailing Address - Country:US
Mailing Address - Phone:316-927-3010
Mailing Address - Fax:316-777-6707
Practice Address - Street 1:650 N CARRIAGE PKWY STE 135
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4514
Practice Address - Country:US
Practice Address - Phone:316-927-3010
Practice Address - Fax:316-777-6707
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3169OtherLICENSE