Healthcare Provider Details

I. General information

NPI: 1063324713
Provider Name (Legal Business Name): TAMARA TOOMBS ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 S BROADWAY AVE
WICHITA KS
67211-3129
US

IV. Provider business mailing address

1407 S BROADWAY AVE
WICHITA KS
67211-3129
US

V. Phone/Fax

Practice location:
  • Phone: 316-973-8984
  • Fax:
Mailing address:
  • Phone: 316-973-8984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2761988116
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: