Organization
P.A.T.H. CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGIA DENNE (MANAGER)
(316) 269-5000
Entity
Organization
Contact information
Practice address
9342 E CENTRAL AVE STE D, WICHITA, KS 67206-2555
(316) 269-5000
(316) 269-0404
Mailing address
9342 E CENTRAL AVE STE D, WICHITA, KS 67206-2555
(316) 269-5000
(316) 269-0404
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0718
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066958
BCBS
KS
Enumeration date
12/12/2006
Last updated
08/22/2020
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