Provider Demographics
NPI:1578701454
Name:WURTZ, PHILIP J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:WURTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2835 SW BURLINGAME RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1382
Mailing Address - Country:US
Mailing Address - Phone:785-266-0646
Mailing Address - Fax:620-341-5801
Practice Address - Street 1:1512 W 6TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2400
Practice Address - Country:US
Practice Address - Phone:620-343-1711
Practice Address - Fax:620-341-5801
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS134 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional