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NPI Code Detail

MEDICARE: PETER J NINEMIRE LSCSW, LCAC

MEDICARE: PETER J NINEMIRE LSCSW, LCAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor344KS
2101YA0400XAddiction (Substance Use Disorder) Counselor
3104100000XSocial Worker6503KS
41041C0700XClinical Social Worker4326KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790933943
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER J NINEMIRE LSCSW, LCAC
Provider Business Mailing Address
First Line : 714 S HILLSIDE ST
Second Line :
City : WICHITA
State : KS
Zip : 67211-3002
Country : US
Telephone Number : 316-295-4800
Fax Number : 316-295-4811
Provider Business Practice Location Address
First Line : 714 S HILLSIDE ST
Second Line :
City : WICHITA
State : KS
Zip : 67211-3002
Country : US
Telephone Number : 316-295-4800
Fax Number : 316-295-4811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 08/12/2022

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1790912095 — MS. JILL DENISE HOOPES LSCSW
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Practice Fax:
1548526296 — PETER NINEMIRE COUNSELING
Practice Location Address:
714 S HILLSIDE ST
WICHITA, KS
67211-3002
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Practice Fax:
1851736607 — JENNIFER K MACKEY LMSW, LAC
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1972926558 — MS. DEAH MILLER LMSW, LCAC
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714 S HILLSIDE ST
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67211-3002
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Practice Fax: 316-295-4811

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