Provider Demographics
NPI:1750756474
Name:PACHOLSKI, TYLER W (LMFT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:W
Last Name:PACHOLSKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2249
Mailing Address - Country:US
Mailing Address - Phone:316-691-0249
Mailing Address - Fax:316-691-9939
Practice Address - Street 1:2707 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2249
Practice Address - Country:US
Practice Address - Phone:316-691-0249
Practice Address - Fax:316-691-9939
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist