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NPI Code Detail

MEDICARE: MR. HARLEY V GULLETT ACSW, LCSW

MEDICARE: MR. HARLEY V GULLETT ACSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker000440MO

General Provider Information

NPI Number : 1265416770
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HARLEY V GULLETT ACSW, LCSW
Provider Business Mailing Address
First Line : 100 S PREWITT ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-1760
Country : US
Telephone Number : 417-667-8700
Fax Number : 417-667-7382
Provider Business Practice Location Address
First Line : 100 S PREWITT ST
Second Line :
City : NEVADA
State : MO
Zip : 64772-1760
Country : US
Telephone Number : 417-667-8700
Fax Number : 417-667-7382
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2005
Last Update Date : 07/08/2007

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