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1740664648
MIKETO MICHELLE KIRK
WICHITA, KS
NPI
1740664648
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: KS 680)
Enumeration Date
2015-07-10
Last Update Date
2015-07-10
Business Address
-- MIKETO MICHELLE KIRK A.A., LAC
2050 WEST 11TH ST.
WICHITA, KS 67203
Phone number: 316-267-5710
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Mailing Address
-- MIKETO MICHELLE KIRK A.A., LAC
1902 E LOOMAN ST
WICHITA, KS 67219-4532
Phone number: 316-267-5710
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