Healthcare Provider Details

I. General information

NPI: 1255530788
Provider Name (Legal Business Name): MICHAEL PAUL OHLDE PSYD, LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE OHLDE

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N ROCK RD STE 170
WICHITA KS
67206-2287
US

IV. Provider business mailing address

250 N ROCK RD STE 170
WICHITA KS
67206-2287
US

V. Phone/Fax

Practice location:
  • Phone: 316-358-7257
  • Fax: 316-358-7002
Mailing address:
  • Phone: 316-358-7257
  • Fax: 316-358-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2156
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: