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General NPI Number Information
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NPI Number | 1194785337
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Entity Type | Organization
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Legal Business Name | FAMILY PSYCHOLOGICAL CENTER, P.A.
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 804 S OLIVER ST
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City | WICHITA
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State | KS
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Zip | 67218-2329
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Country | US
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Telephone | 316-685-9311
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Fax | 316-685-6101
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Provider Business Mailing Address
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Address Line | 804 S OLIVER ST
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City | WICHITA
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State | KS
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Zip | 67218-2329
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Country | US
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Telephone | 316-685-9311
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Fax | 316-685-6101
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JEFFREY R LANE
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Credential | PH.D.
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Telephone | 316-685-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0391
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 0165
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1034
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0626
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0683
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License Number State | KS
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 117
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License Number State | KS
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Taxonomy #7
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5522
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License Number State | KS
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