Healthcare Provider Details

I. General information

NPI: 1255857355
Provider Name (Legal Business Name): TARA GALYARDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST STE 505
WICHITA KS
67202-3738
US

IV. Provider business mailing address

100 S MAIN ST STE 505
WICHITA KS
67202-3738
US

V. Phone/Fax

Practice location:
  • Phone: 316-688-8390
  • Fax: 316-867-1718
Mailing address:
  • Phone: 316-688-8390
  • Fax: 316-867-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3781
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05686
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: