Doctor Name: | DAVID SCOTT KETCHAM |
NPI Number: | 1609180041 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BA |
License Number: | CAP -19 |
Business Practice Address: | 143 Sonora Ct Rawlins, WY - 823015115 |
Business Phone Number: | 3073247156 |
Business Fax Number: | 3073281651 |
Mailing Address: | 143 Sonora Ct, RAWLINS |
State: | WY |
Postal Code: | 823015115 |
Phone Number: | 3073247156 |
Fax Number: | 3073281651 |
NPI Enumeration Date: | 07/27/2010 |
NPI Last Update Date: | 07/27/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CAP -19 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |