1053565481 NPI number — MS. DEBORAH DIMMITT PONTON LSCSW, LCAC

Table of content: MS. DEBORAH DIMMITT PONTON LSCSW, LCAC (NPI 1053565481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053565481 NPI number — MS. DEBORAH DIMMITT PONTON LSCSW, LCAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PONTON
Provider First Name:
DEBORAH
Provider Middle Name:
DIMMITT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSCSW, LCAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIMMITT
Provider Other First Name:
DEBBY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053565481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1005 N BUCKEYE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67410-1940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-236-8612
Provider Business Mailing Address Fax Number:
785-783-5366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 N. BUCKEYE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-341-7931
Provider Business Practice Location Address Fax Number:
785-823-3109
Provider Enumeration Date:
11/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4131 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LMSW 6091 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)