Individual
FRED GAMMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
T-LAC
Contact information
Practice address
6610 SE QUAKERVALE RD, RIVERTON, KS 66770-4185
(620) 848-2300
(620) 848-2301
Mailing address
PO BOX 550, RIVERTON, KS 66770-0550
(620) 848-2300
(620) 848-2301
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1139
KS
Other
Enumeration date
03/27/2014
Last updated
03/27/2014
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