Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 4877 | KS |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 001 | KS |
N | 101YM0800X | Mental Health Counselor | 4877 | KS |
N | 101YP1600X | Pastoral Counselor | ||
N | 104100000X | Social Worker | 4877 | KS |
Y | 1041C0700X | Clinical Social Worker | 4877 | KS |
NPI | 1164893699 |
---|---|
Provider Name | Raymond Michael Gillett |
First Address | Wichita, KS 67212-3141 |
Second Address | Wichita, KS 67212-3141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2015 |
Last Update Date | 19/03/2019 |