=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588182752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARL NITZ COUNSELING AND MENTAL TOUGHNESS TRAINING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2017
-----------------------------------------------------
Last Update Date | 10/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 E IRON AVE
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-3401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-829-3154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 549 S 8TH ST
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-829-3154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KARL CHRISTIAN NITZ
-----------------------------------------------------
Credential | LSCSW
-----------------------------------------------------
Telephone | 785-829-3154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 2528
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------