MEDICARE: INSIDE OUT COUNSELING SSERVICE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1538496518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIDE OUT COUNSELING SSERVICE

Provider Business Mailing Address
First Line	:	1421 ESPLANADE AVE
Second Line	:	#7
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-5956
Country	:	US
Telephone Number	:	541-273-0340
Fax Number	:	541-273-0340

Provider Business Practice Location Address
First Line	:	1421 ESPLANADE AVE
Second Line	:	#7
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-5956
Country	:	US
Telephone Number	:	541-273-0340
Fax Number	:	541-273-0340

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. JANENE LOUISE LEE
Credential	:
Telephone Number	:	541-273-0340

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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