MEDICARE: KATELYN P NABORS 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	101YP2500X	Professional Counselor	P1912148	AR

General Provider Information

NPI Number	:	1356712616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN P NABORS LPC

Provider Business Mailing Address
First Line	:	1906 N 29TH ST
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-2418
Country	:	US
Telephone Number	:	479-650-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 DALLAS ST STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5037
Country	:	US
Telephone Number	:	479-210-2146
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	11/20/2022

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