Nystrom, Bruce
Nystrom, Bruce is an sole proprietor health care provider with primary practice located at 4013 N Ridge Rd Ste 110 , Wichita KS 67205-8859. He recently has 10 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Adult Development & Aging, Behavioral Health & Social Service Providers / Cognitive & Behavioral, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Forensic, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Nystrom, Bruce can be contacted via phone (316) 616-0260.Contact Information
Primary practice address
4013 N Ridge Rd Ste 110
Wichita KS 67205-8859
Phone: (316) 616-0260
Fax: (316) 616-0264
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 103TA0400X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Adult Development & Aging | 103TA0700X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Cognitive & Behavioral | 103TB0200X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Family | 103TF0000X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Forensic | 103TF0200X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Health Service | 103TH0100X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Group Psychotherapy | 103TP2701X | 610 | Kansas |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 610 | Kansas |
Profile Details
| NPI number | 1700983368 |
|---|---|
| LBN Legal business name | Nystrom, Bruce |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 17th, 2006 |
| Last updated | Aug 30th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700983368 | NPPES |
| Kansas | MEDICAID | 100239970 B |
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