Provider Demographics
NPI:1205304763
Name:MATHIS, EDWARD ALAN (LAC MA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ALAN
Last Name:MATHIS
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Gender:M
Credentials:LAC MA
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Mailing Address - Street 1:1220 GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3330
Mailing Address - Country:US
Mailing Address - Phone:785-643-9778
Mailing Address - Fax:785-819-3301
Practice Address - Street 1:1220 GREELEY AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3330
Practice Address - Country:US
Practice Address - Phone:785-643-9778
Practice Address - Fax:785-819-3301
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)