Doctor Name: | DONNA BOTINELLY |
NPI Number: | 1316110471 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LCAC 467 |
Business Practice Address: | 1604 W 4th St Coffeyville, KS - 673373334 |
Business Phone Number: | 6202518180 |
Business Fax Number: | 6202518180 |
Mailing Address: | Po Box 688, INDEPENDENCE |
State: | KS |
Postal Code: | 673010688 |
Phone Number: | 6203311748 |
Fax Number: | 6203311748 |
NPI Enumeration Date: | 04/10/2008 |
NPI Last Update Date: | 09/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LCAC 467 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |