MEDICARE: KAITLYN FAIN

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	CTB20230499	NM

General Provider Information

NPI Number	:	1639854698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN FAIN

Provider Business Mailing Address
First Line	:	5046 INSPIRATION LN UNIT 2
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6121
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 INSPIRATION LN UNIT 2
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6121
Country	:	US
Telephone Number	:	302-650-2246
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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Directions to “ KAITLYN FAIN ” Practice Location

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