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General NPI Number Information
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NPI Number | 1619517323
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Entity Type | Organization
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Legal Business Name | MUTH, INC.
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 1916 16TH ST
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City | GREAT BEND
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State | KS
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Zip | 67530-4001
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Country | US
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Telephone | 620-792-5405
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Fax |
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Provider Business Mailing Address
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Address Line | 1842 CR 370 RD
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City | ALBERT
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State | KS
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Zip | 67511
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Country | US
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Telephone | 620-617-5497
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARITY A MUTH
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Credential | MS,LPC,LCAC
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Telephone | 620-617-5497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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