Healthcare Provider Details

I. General information

NPI: 1952337370
Provider Name (Legal Business Name): THOMAS L ROCHAT PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EASY ST
GODDARD KS
67052-9211
US

IV. Provider business mailing address

6120 SHADYBROOK ST
WICHITA KS
67208-1862
US

V. Phone/Fax

Practice location:
  • Phone: 316-794-8635
  • Fax:
Mailing address:
  • Phone: 316-269-5000
  • Fax: 316-269-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP-819
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: