Provider Demographics
NPI:1477967420
Name:GASSER, PETER (LPC, LMAC)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GASSER
Suffix:
Gender:M
Credentials:LPC, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 5TH ST
Mailing Address - Street 2:PO BOX 711
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2206
Mailing Address - Country:US
Mailing Address - Phone:316-283-6743
Mailing Address - Fax:316-283-6830
Practice Address - Street 1:6221 RICHARDS DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1724
Practice Address - Country:US
Practice Address - Phone:913-248-1943
Practice Address - Fax:913-248-1994
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS114101YA0400X
KS2619101YP2500X
KS1152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100106710 IMedicaid