Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1058 | KS |
N | 101YP2500X | Professional Counselor | 2059 | KS |
NPI | 1003203076 |
---|---|
Provider Name | Melanie Renee Privat |
First Address | Lawrence, KS 66049 |
Second Address | Lawrence, KS 66049-4609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 17/04/2015 |