Provider Demographics
NPI:1912297334
Name:STONE, BRIAN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:STONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4055
Mailing Address - Country:US
Mailing Address - Phone:316-773-4081
Mailing Address - Fax:316-684-7328
Practice Address - Street 1:1138 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4055
Practice Address - Country:US
Practice Address - Phone:316-773-4081
Practice Address - Fax:316-684-7328
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP1073103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist