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General NPI Number Information
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NPI Number | 1003225947
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Entity Type | Organization
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Legal Business Name | WICHITA STATE UNIVERSITY
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 1845 FAIRMOUNT BOX 91
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City | WICHITA
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State | KS
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Zip | 67260-0091
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Country | US
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Telephone | 502-821-7904
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 FAIRMOUNT BOX 91
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City | WICHITA
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State | KS
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Zip | 67260-0091
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Country | US
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Telephone | 502-821-7904
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGY INTERN
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Name | MR. JASON DOUGLAS BEYER
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Credential | MA
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Telephone | 502-821-7904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0914
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License Number State | KY
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