Healthcare Provider Details

I. General information

NPI: 1316473929
Provider Name (Legal Business Name): MELCHIZEDEK NTIM LMLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MELCHIZEDEK NTIM GYAKARI

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SW GAGE BLVD
TOPEKA KS
66604-3340
US

IV. Provider business mailing address

3610 SW WOODVALLEY TER
TOPEKA KS
66614-3551
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-0778
  • Fax:
Mailing address:
  • Phone: 785-217-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberTLMLP 2717
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLMLP2884
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: