Healthcare Provider Details

I. General information

NPI: 1730984048
Provider Name (Legal Business Name): PEERLINK PREMIER PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 PARKWOOD LN
NEWTON KS
67114-4837
US

IV. Provider business mailing address

1209 PARKWOOD LN
NEWTON KS
67114-4837
US

V. Phone/Fax

Practice location:
  • Phone: 316-665-0311
  • Fax:
Mailing address:
  • Phone: 316-665-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA M RUPERT
Title or Position: OWNER/OPERATOR
Credential:
Phone: 316-665-0311