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Contact Information

BRUCE NYSTROM, PHD
4013 N RIDGE RD STE 110
WICHITA, KS67205-8859
 Phone: 316-616-0260
 Fax: 316-616-0264
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
 

Adult Development & Aging

103TA0700X 62 Psychologist, Clinical
 

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
 

Cognitive & Behavioral

103TB0200X 62 Psychologist, Clinical
 

Family

103TF0000X 62 Psychologist, Clinical
 

Forensic

103TF0200X 62 Psychologist, Clinical
 

Group Psychotherapy

103TP2701X 62 Psychologist, Clinical
 

Health Service

103TH0100X 62 Psychologist, Clinical
 

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for BRUCE NYSTROM · (Male)

NPI # 1700983368
Status Active
Credentials PHD
Entity Individual
Enumeration date 09/17/2006
Last updated 08/30/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • KS License # 610
  • KS Medicaid 100239970 B
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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