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General NPI Number Information
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NPI Number | 1922469618
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Entity Type | Organization
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Legal Business Name | ANDERSON COUNTY MENTAL HEALTH
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 200 S MAPLE ST
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City | GARNETT
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State | KS
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Zip | 66032-1017
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Country | US
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Telephone | 785-204-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 200 S MAPLE ST
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City | GARNETT
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State | KS
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Zip | 66032-1017
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Country | US
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Telephone | 785-204-4357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN DEAN NUTT
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Credential | LSCSW, LAC
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Telephone | 785-204-4357
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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