Healthcare Provider Details

I. General information

NPI: 1841535127
Provider Name (Legal Business Name): MR. ERIC A MCDANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 E 21ST ST N STE 102
WICHITA KS
67206-2927
US

IV. Provider business mailing address

2365 W CENTRAL AVE
EL DORADO KS
67042-3208
US

V. Phone/Fax

Practice location:
  • Phone: 316-766-8200
  • Fax:
Mailing address:
  • Phone: 316-321-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2425
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: