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General NPI Number Information
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NPI Number | 1649695446
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Entity Type | Organization
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Legal Business Name | PETER NINEMIRE COUNSELING
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 714 S HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67211-3002
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Country | US
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Telephone | 316-295-4800
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Fax | 316-295-4811
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Provider Business Mailing Address
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Address Line | 714 S HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67211-3002
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Country | US
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Telephone | 316-295-4800
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Fax | 316-295-4811
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. PETER NINEMIRE
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Credential | LMSW, LCAC
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Telephone | 315-295-4800
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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 | 344
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6503
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License Number State | KS
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