Provider Demographics
NPI:1780144089
Name:MUZYK, NILES PATRICK (PSYD)
Entity type:Individual
Prefix:DR
First Name:NILES
Middle Name:PATRICK
Last Name:MUZYK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4227
Mailing Address - Country:US
Mailing Address - Phone:201-983-7921
Mailing Address - Fax:
Practice Address - Street 1:1200 SCHWEGLER DR RM 2100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7558
Practice Address - Country:US
Practice Address - Phone:785-864-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP2588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical