Healthcare Provider Details

I. General information

NPI: 1457448201
Provider Name (Legal Business Name): WAYNE C PIERSEL PHD PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 E 29TH STREET NORTH
WICHITA KS
67226-2169
US

IV. Provider business mailing address

8700 E 29TH STREET NORTH
WICHITA KS
67226-2169
US

V. Phone/Fax

Practice location:
  • Phone: 316-634-8710
  • Fax: 316-634-8850
Mailing address:
  • Phone: 316-634-8710
  • Fax: 316-634-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1051
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1051
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1051
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1051
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1051
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1051
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1051
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: