Basic Information
| Provider Information | |||||||||
| NPI: | 1699133942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWE | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | E. | ||||||||
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| OtherLastName: | HOWE | ||||||||
| OtherFirstName: | KENNETH | ||||||||
| OtherMiddleName: | E. | ||||||||
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| OtherCredential: | M.DIV., CFLE, MATS | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7509 CHARLESTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122564686 | ||||||||
| FaxNumber: | 8122564415 | ||||||||
| Practice Location | |||||||||
| Address1: | 7509 CHARLESTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122564686 | ||||||||
| FaxNumber: | 8122564415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2016 | ||||||||
| LastUpdateDate: | 02/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | MATS-#145 | IN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.