MEDICARE: KAELYN PATE

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	106H00000X	Marriage & Family Therapist	204673	TX

General Provider Information

NPI Number	:	1366299489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAELYN PATE

Provider Business Mailing Address
First Line	:	110 W OTIS AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-8713
Country	:	US
Telephone Number	:	785-825-0541
Fax Number	:	785-825-0062

Provider Business Practice Location Address
First Line	:	125 CHICAGO AVE
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79416-1605
Country	:	US
Telephone Number	:	785-825-0541
Fax Number	:

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

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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Directions to “ KAELYN PATE ” Practice Location

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