Healthcare Provider Details

I. General information

NPI: 1073409348
Provider Name (Legal Business Name): ICT PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 E 44TH ST N
BEL AIRE KS
67226-1483
US

IV. Provider business mailing address

6519 E 44TH ST N
BEL AIRE KS
67226-1483
US

V. Phone/Fax

Practice location:
  • Phone: 316-847-2452
  • Fax:
Mailing address:
  • Phone: 316-847-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. SIEGFRIED F MBOYA
Title or Position: PMHNP- BC
Credential: NP
Phone: 316-847-2452