Healthcare Provider Details

I. General information

NPI: 1255390423
Provider Name (Legal Business Name): KARL C NITZ LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 HOLLY LN
SALINA KS
67401-8452
US

IV. Provider business mailing address

400 S SANTA FE AVE
SALINA KS
67401-4144
US

V. Phone/Fax

Practice location:
  • Phone: 785-452-4930
  • Fax: 785-452-4932
Mailing address:
  • Phone: 785-452-7706
  • Fax: 785-452-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2528
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: