MEDICARE: PSYCH CREDENTIALING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851256531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCH CREDENTIALING

Provider Business Mailing Address
First Line	:	300 W DOUGLAS AVE STE 250
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-2918
Country	:	US
Telephone Number	:	316-803-2535
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W DOUGLAS AVE STE 250
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67202-2918
Country	:	US
Telephone Number	:	316-803-2535
Fax Number	:

Authorized Official
Title or Position	:	BILLING SPECIALIST
Name	:	WILLIAM S LAUDICK
Credential	:
Telephone Number	:	316-803-2535

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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Directions to “PSYCH CREDENTIALING ” Practice Location

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