Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | KS |
NPI | 1003877051 |
---|---|
Provider Name | Owen F Mccourt |
First Address | Topeka, KS 66606-2330 |
Second Address | Topeka, KS 66606-1995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 08/07/2007 |