Healthcare Provider Details

I. General information

NPI: 1629861349
Provider Name (Legal Business Name): PERRY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 N ROCK RD STE A100
WICHITA KS
67206-1271
US

IV. Provider business mailing address

3260 N OLIVER ST
WICHITA KS
67220-2105
US

V. Phone/Fax

Practice location:
  • Phone: 316-641-5242
  • Fax:
Mailing address:
  • Phone: 316-641-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. PERRY A MALZAHN
Title or Position: MENTAL HEALTH THERAPIST
Credential: LSCSW
Phone: 316-641-5242