MEDICARE: MS. KAY E FREYER-ROSE RN, CRAADC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	001294	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	871	MO
3	101YM0800X	Mental Health Counselor	001294	MO
4	163W00000X	Registered Nurse	097768	MO
5	101YP2500X	Professional Counselor	001294	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20253013	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013585512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAY E FREYER-ROSE RN, CRAADC, LPC

Provider Business Mailing Address
First Line	:	101 E GREGORY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1119
Country	:	US
Telephone Number	:	816-806-7760
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 E GREGORY BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1119
Country	:	US
Telephone Number	:	816-806-7760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2021
Last Update Date	:	06/12/2021

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