Healthcare Provider Details

I. General information

NPI: 1255443651
Provider Name (Legal Business Name): CHRISTOPHER A EBBERWEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10222 W CENTRAL AVE STE 202
WICHITA KS
67212-4613
US

IV. Provider business mailing address

10222 W CENTRAL AVE STE 202
WICHITA KS
67212-4613
US

V. Phone/Fax

Practice location:
  • Phone: 316-773-9525
  • Fax: 316-773-2012
Mailing address:
  • Phone: 316-773-9525
  • Fax: 316-773-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1136
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: