Healthcare Provider Details

I. General information

NPI: 1598459000
Provider Name (Legal Business Name): WSU PSYCHOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PSYCHOLOGY - WSU PSYCHOLOGY CLINIC 1845 FAIRMOUNT ST CAMPUS
WICHITA KS
67260
US

IV. Provider business mailing address

DEPARTMENT OF PSYCHOLOGY - WSU PSYCHOLOGY CLINIC 1845 FAIRMOUNT ST CAMPUS BOX 34
WICHITA KS
67260
US

V. Phone/Fax

Practice location:
  • Phone: 316-978-3170
  • Fax: 316-978-3086
Mailing address:
  • Phone: 316-978-3170
  • Fax: 316-978-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE RENEE PATRICK
Title or Position: FACULTY
Credential: PH.D. PSYCHOLOGIST
Phone: 316-978-3212