Healthcare Provider Details

I. General information

NPI: 1508806837
Provider Name (Legal Business Name): DENNIS HERL LCP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 N WATER ST
WICHITA KS
67203-3838
US

IV. Provider business mailing address

635 N MAIN ST
WICHITA KS
67203-3602
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7525
  • Fax: 316-383-4590
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-383-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0222
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: