MEDICARE: DR. ROMA G DREVETS PH.D,LCPC,AAPS

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	598	KS
2	101YM0800X	Mental Health Counselor	LCPC 179	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	119849	OTHER	KS	BLUE CROSS BLUE SHIELD KS

General Provider Information

NPI Number	:	1902802820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMA G DREVETS PH.D,LCPC,AAPS

Provider Business Mailing Address
First Line	:	PO BOX 2103
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67402-2103
Country	:	US
Telephone Number	:	785-823-1961
Fax Number	:	785-827-1401

Provider Business Practice Location Address
First Line	:	1700 E IRON AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3401
Country	:	US
Telephone Number	:	785-823-1961
Fax Number	:	785-827-1401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	03/18/2009

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