MEDICARE: BEVERLY KUNE LPCC, LMT

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	LPCC 1565	NM

General Provider Information

NPI Number	:	1396754990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY KUNE LPCC, LMT

Provider Business Mailing Address
First Line	:	PO BOX 22904
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-2904
Country	:	US
Telephone Number	:	505-988-4816
Fax Number	:	505-988-4816

Provider Business Practice Location Address
First Line	:	1474 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4038
Country	:	US
Telephone Number	:	505-988-4816
Fax Number	:	505-988-4816

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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