Bruce Nystrom, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

610 Issued in KS

Practice address

4013 N Ridge Rd Ste 110
Wichita, KS 67205-8859

Phone

(316) 616-0260

Fax

(316) 616-0264

NPI assigned

Sep 17, 2006

Last updated

Aug 30, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 10

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Counseling & Mediation Center Inc

  • Clinical Social Worker
  • Wichita, KS
  • NPI 1013021401
  NPD (past)
• Counseling and Mediation Center, Inc.

  • Professional Counselor
  • Dodge City, KS
  • NPI 1932585577
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1700983368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "727 N WACO AVE STE 320",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672033972",
            "telephone_number": "316-616-0260",
            "fax_number": "316-616-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 N RIDGE RD STE 110",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672058859",
            "telephone_number": "316-616-0260",
            "fax_number": "316-616-0264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYSTROM",
        "first_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KS",
            "license": "610",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "KS",
            "license": "610",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "KS",
            "license": "610",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100239970 B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emmanuel H Nyanchini
• Eboni Nyangau, RN
• Sue M Nyberg, P.A.
• Linda Nye, RD, LD
• Sajda Ismail Nyimbo
• Robbie O'Brien-Leighton, MD
• Alexandria Nicole O'Brien, NP
• Amanda M O'Brien, OTR/L
• Erin O'Bryan, PHD, CCC-SLP
• Amy Elizabeth O'Byrne, P.A.-C

• Clinical Psychologist in Wichita, KS
• Providers in Wichita, KS by specialty
• Clinical Psychologist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.