Provider Demographics
NPI:1538621925
Name:BEAR, CATHIE (LCAC)
Entity type:Individual
Prefix:
First Name:CATHIE
Middle Name:
Last Name:BEAR
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ANDERSON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2809
Mailing Address - Country:US
Mailing Address - Phone:785-579-9199
Mailing Address - Fax:
Practice Address - Street 1:2601 ANDERSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2809
Practice Address - Country:US
Practice Address - Phone:785-579-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2023-08-22
Deactivation Date:2021-01-07
Deactivation Code:
Reactivation Date:2021-04-07
Provider Licenses
StateLicense IDTaxonomies
KS757101YA0400X
KS00838101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)