Provider Demographics
NPI:1962692558
Name:SPRADLIN, SCOTT EDWARD (LPC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDWARD
Last Name:SPRADLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2351
Mailing Address - Country:US
Mailing Address - Phone:316-260-1127
Mailing Address - Fax:316-260-1137
Practice Address - Street 1:560 S OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2351
Practice Address - Country:US
Practice Address - Phone:316-260-1127
Practice Address - Fax:316-260-1137
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS813101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12206146OtherCAQH
KS200438340BOtherKMAP