MEDICARE: MR. DAVID DUANE SORRICK MASTER OF SCIENCE, L

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	106H00000X	Marriage & Family Therapist	186	KS

General Provider Information

NPI Number	:	1972966497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID DUANE SORRICK MASTER OF SCIENCE, L

Provider Business Mailing Address
First Line	:	1999 NORTH AMIDON
Second Line	:	SUITE 232
City	:	WICHITA
State	:	KS
Zip	:	67203
Country	:	US
Telephone Number	:	620-213-1110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 NORTH AMIDON
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203
Country	:	US
Telephone Number	:	620-213-1110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	04/01/2016

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