Provider Demographics
NPI:1144701194
Name:SCULLY-SKINNER, ANA LIZA (LCMFT)
Entity type:Individual
Prefix:
First Name:ANA LIZA
Middle Name:
Last Name:SCULLY-SKINNER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N RIDGE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4400
Mailing Address - Country:US
Mailing Address - Phone:316-409-0565
Mailing Address - Fax:858-915-0285
Practice Address - Street 1:151 N RIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4400
Practice Address - Country:US
Practice Address - Phone:316-409-0565
Practice Address - Fax:858-915-0285
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist