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1710083183
JESSICA LYNN PROVINES
WICHITA, KS
NPI
1710083183
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103TC0700X Psychologist, Clinical
(Licence: KS 997)
Enumeration Date
2006-09-15
Last Update Date
2007-07-08
Business Address
-- JESSICA LYNN PROVINES TLMLP
7570 W 21ST ST N
WICHITA, KS 67205-1734
Phone number: 316-729-6555
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Mailing Address
-- JESSICA LYNN PROVINES TLMLP
1545 N HOOD ST
WICHITA, KS 67203-2846
Phone number: 316-655-9964
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