Provider Demographics
NPI:1649695446
Name:PETER NINEMIRE COUNSELING
Entity type:Organization
Organization Name:PETER NINEMIRE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NINEMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCAC
Authorized Official - Phone:315-295-4800
Mailing Address - Street 1:714 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-3002
Mailing Address - Country:US
Mailing Address - Phone:316-295-4800
Mailing Address - Fax:316-295-4811
Practice Address - Street 1:714 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3002
Practice Address - Country:US
Practice Address - Phone:316-295-4800
Practice Address - Fax:316-295-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS344101YA0400X
KS6503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty