Provider Demographics
NPI:1255390423
Name:NITZ, KARL C (LSCSW)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:C
Last Name:NITZ
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4144
Mailing Address - Country:US
Mailing Address - Phone:785-452-7706
Mailing Address - Fax:785-452-7279
Practice Address - Street 1:730 HOLLY LN
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-8452
Practice Address - Country:US
Practice Address - Phone:785-452-4930
Practice Address - Fax:785-452-4932
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200354330AMedicaid
KS070805Medicare ID - Type Unspecified
KS200354330AMedicaid