Provider Demographics
NPI:1043354343
Name:LEARY, MICHAEL JAMES (MED, LCPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:LEARY
Suffix:
Gender:M
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 E OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1716
Mailing Address - Country:US
Mailing Address - Phone:316-685-2922
Mailing Address - Fax:
Practice Address - Street 1:8020 E CENTRAL AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2360
Practice Address - Country:US
Practice Address - Phone:316-634-0029
Practice Address - Fax:316-634-0029
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional