Provider Demographics
NPI:1861745903
Name:BRUNSON, CHRISTOPHER WILLIAM (LCPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 E MAINSGATE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-1062
Mailing Address - Country:US
Mailing Address - Phone:316-461-7923
Mailing Address - Fax:316-260-7045
Practice Address - Street 1:6525 E MAINSGATE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1062
Practice Address - Country:US
Practice Address - Phone:316-461-7923
Practice Address - Fax:316-260-7045
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2415101YM0800X
KS03241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201084140AMedicaid