Provider Demographics
NPI:1104270396
Name:DYCK, CATHERINE (LMFT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:DYCK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MISSION RD
Mailing Address - Street 2:SUITE 337
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3006
Mailing Address - Country:US
Mailing Address - Phone:316-772-1051
Mailing Address - Fax:
Practice Address - Street 1:7301 MISSION RD
Practice Address - Street 2:SUITE 337
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3006
Practice Address - Country:US
Practice Address - Phone:316-772-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist