Provider Demographics
NPI:1073491577
Name:SELVIDGE, LESLEY RAE (T-LMFT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:RAE
Last Name:SELVIDGE
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S EMPORIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3211
Mailing Address - Country:US
Mailing Address - Phone:316-660-9494
Mailing Address - Fax:
Practice Address - Street 1:1211 S EMPORIA AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3211
Practice Address - Country:US
Practice Address - Phone:316-660-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03762-T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist