DR. BRUCE NYSTROM PHD NPI 1700983368

NPI Information

NPI: 1700983368
Provider Name: DR. BRUCE NYSTROM, PHD
Classification: Psychologist - 103TA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
727 N WACO AVE STE 320
WICHITA, KS
ZIP 67203
Phone: (316) 616-0260
Get Directions

DR. Bruce Nystrom, PHD is an addiction (substance use disorder) psychologist in Wichita, KS. The provider is a psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior. DR. Bruce Nystrom, PHD NPI is 1700983368. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

727 N WACO AVE STE 320
WICHITA, KS
ZIP 67203-972
Phone: (316) 616-0260
Fax: (316) 616-0264

The enumeration date for this NPI number is 9/17/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TA0400X	Psychologist	Addiction (Substance Use Disorder)	610	KANSAS	Yes
2	103TA0700X	Psychologist	Adult Development & Aging	610	KANSAS	X
3	103TB0200X	Psychologist	Cognitive & Behavioral	610	KANSAS	X
4	103TC0700X	Psychologist	Clinical	610	KANSAS	X
5	103TC2200X	Psychologist	Clinical Child & Adolescent	610	KANSAS	X
6	103TF0000X	Psychologist	Family	610	KANSAS	X
7	103TF0200X	Psychologist	Forensic	610	KANSAS	X
8	103TH0100X	Psychologist	Health Service	610	KANSAS	X
9	103T00000X	Psychologist		610	KANSAS	X
10	103TP2701X	Psychologist	Group Psychotherapy	610	KANSAS	X

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	119714	MEDICARE ID-TYPE UNSPECIFIED	KANSAS
2	R31094	MEDICARE UPIN	KANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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