Provider Demographics
NPI:1578864450
Name:BURNS, ANITA RAYLENE (LMFT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:RAYLENE
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 SE 120TH ST
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:KS
Mailing Address - Zip Code:67074-9067
Mailing Address - Country:US
Mailing Address - Phone:316-519-1480
Mailing Address - Fax:
Practice Address - Street 1:1825 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3957
Practice Address - Country:US
Practice Address - Phone:316-440-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist