Healthcare Provider Details

I. General information

NPI: 1578701454
Provider Name (Legal Business Name): PHILIP J WURTZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 W 6TH AVE SUITE A
EMPORIA KS
66801-2400
US

IV. Provider business mailing address

2835 SW BURLINGAME RD
TOPEKA KS
66611-1382
US

V. Phone/Fax

Practice location:
  • Phone: 620-343-1711
  • Fax: 620-341-5801
Mailing address:
  • Phone: 785-266-0646
  • Fax: 620-341-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number134 LCPC
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: