Provider Demographics
NPI:1033751276
Name:MUTH, CHARITY ANN (LCAC/LPC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:ANN
Last Name:MUTH
Suffix:
Gender:F
Credentials:LCAC/LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 CR 370 RD
Mailing Address - Street 2:
Mailing Address - City:ALBERT
Mailing Address - State:KS
Mailing Address - Zip Code:67511
Mailing Address - Country:US
Mailing Address - Phone:620-617-5497
Mailing Address - Fax:
Practice Address - Street 1:1916 16TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4001
Practice Address - Country:US
Practice Address - Phone:620-792-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)