Individual
PERVIS POE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2200 SW GAGE BLVD, TOPEKA, KS 66622-0001
(785) 350-3111
Mailing address
4521 SW WANAMAKER RD, TOPEKA, KS 66610-1337
(313) 757-0343
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60537148
WA
106H00000X
Marriage & Family Therapist
Primary
MT3349
FL
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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