Healthcare Provider Details

I. General information

NPI: 1104739721
Provider Name (Legal Business Name): ELISSA MARIE M HOVEY ED.S., NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 S EDGEMOOR ST
WICHITA KS
67218-3337
US

IV. Provider business mailing address

1606 WEILE ST
WINFIELD KS
67156-5257
US

V. Phone/Fax

Practice location:
  • Phone: 620-660-2176
  • Fax:
Mailing address:
  • Phone: 620-660-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5771443824
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: