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General NPI Number Information
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NPI Number | 1477960219
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Entity Type | Individual
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Provider Name | ANDREW HAWORTH M.A.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 304 N JEFFERSON AVE
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City | IOLA
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State | KS
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Zip | 66749-2327
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Country | US
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Telephone | 620-365-5717
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 S EVERGREEN AVE
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City | CHANUTE
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State | KS
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Zip | 66720-3160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2539
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License Number State | KS
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