MEDICARE: K&M MENTAL HEALTH CLINIC LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1639888621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K&M MENTAL HEALTH CLINIC LLC

Provider Business Mailing Address
First Line	:	10511 BURNISHED BAY LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2972
Country	:	US
Telephone Number	:	832-867-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	10511 BURNISHED BAY LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2972
Country	:	US
Telephone Number	:	832-867-2447
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALICE KEBEUMEN JAMEN
Credential	:	NP
Telephone Number	:	832-867-2447

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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