Provider Demographics
NPI:1528723202
Name:TANDOC, WARREN TYLER
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:TYLER
Last Name:TANDOC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N VOLUTSIA AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4626
Mailing Address - Country:US
Mailing Address - Phone:316-708-1990
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 730
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4267
Practice Address - Country:US
Practice Address - Phone:316-202-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMFT-03325-T106H00000X
KSLMFT-03325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist