MEDICARE: DERRICK PRICHARD LCMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	524	KS
2	106H00000X	Marriage & Family Therapist	678	KS

General Provider Information

NPI Number	:	1710923024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK PRICHARD LCMFT

Provider Business Mailing Address
First Line	:	253 S GRAND MERE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-6428
Country	:	US
Telephone Number	:	316-250-6103
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 S GRAND MERE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67230-6428
Country	:	US
Telephone Number	:	316-250-6103
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	05/07/2024

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