MEDICARE: KATHLEEN A RICE

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	101YM0800X	Mental Health Counselor	8158	NC
2	101YP2500X	Professional Counselor	80058	TX
3	101Y00000X	Counselor	7294	SD
4	101Y00000X	Counselor	80058	TX

General Provider Information

NPI Number	:	1114277118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN A RICE

Provider Business Mailing Address
First Line	:	PO BOX 104
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-0104
Country	:	US
Telephone Number	:	704-738-3558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 N LOOP 336 W STE 424
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1193
Country	:	US
Telephone Number	:	936-506-2966
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	01/25/2024

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Directions to “ KATHLEEN A RICE ” Practice Location

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