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General NPI Number Information
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NPI Number | 1982372520
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Entity Type | Individual
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Provider Name | KAMMIE JO FURMAN LAC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 10320 W MCDOWELL RD STE 7022
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City | AVONDALE
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State | AZ
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Zip | 85392-4871
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Country | US
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Telephone | 623-215-8189
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Fax |
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Provider Business Mailing Address
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Address Line | 3858 E NICOLE AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-0836
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Country | US
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Telephone | 661-993-7216
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-22209
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License Number State | AZ
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