Provider Demographics
NPI:1952337370
Name:ROCHAT, THOMAS L (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:ROCHAT
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 1:6120 SHADYBROOK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1862
Mailing Address - Country:US
Mailing Address - Phone:316-269-5000
Mailing Address - Fax:316-269-0404
Practice Address - Street 1:501 EASY ST
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-9211
Practice Address - Country:US
Practice Address - Phone:316-794-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-819103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100241290BMedicaid
KS004606OtherBCBS
KSR75937Medicare UPIN
KS004606OtherBCBS