Provider Demographics
NPI:1659354041
Name:ATHY, ANNETTE LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:LOUISE
Last Name:ATHY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-1009
Mailing Address - Country:US
Mailing Address - Phone:316-347-8700
Mailing Address - Fax:
Practice Address - Street 1:105 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-1009
Practice Address - Country:US
Practice Address - Phone:316-347-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional