MEDICARE: MRS. KELLY HIGH TROWBRIDGE LCSW

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	101Y00000X	Counselor	CSW002600	GA

General Provider Information

NPI Number	:	1811222821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELLY HIGH TROWBRIDGE LCSW

Provider Business Mailing Address
First Line	:	162 ST. CLAIR DRIVE
Second Line	:
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-1041
Country	:	US
Telephone Number	:	919-638-0638
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 SAINT CLAIR DR
Second Line	:
City	:	SAINT SIMONS ISLAND
State	:	GA
Zip	:	31522-1041
Country	:	US
Telephone Number	:	919-638-0638
Fax Number	:

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

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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