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General NPI Number Information
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NPI Number | 1790933943
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Entity Type | Individual
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Provider Name | PETER J NINEMIRE LSCSW, LCAC
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Gender | Male
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 08/12/2022
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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 |
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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 | 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 | 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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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6503
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4326
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License Number State | KS
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