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General NPI Number Information
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NPI Number | 1578701454
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Entity Type | Individual
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Provider Name | PHILIP J WURTZ PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 1512 W 6TH AVE SUITE A
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City | EMPORIA
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State | KS
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Zip | 66801-2400
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Country | US
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Telephone | 620-343-1711
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Fax | 620-341-5801
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Provider Business Mailing Address
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Address Line | 2835 SW BURLINGAME RD
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City | TOPEKA
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State | KS
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Zip | 66611-1382
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Country | US
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Telephone | 785-266-0646
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Fax | 620-341-5801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 134 LCPC
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License Number State | KS
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