MEDICARE: KARIBU COUNSELING, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1902365521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARIBU COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	3806 WOODCHESTER LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-2934
Country	:	US
Telephone Number	:	347-489-5482
Fax Number	:	866-936-6552

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN STE 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	347-489-5482
Fax Number	:	866-936-6552

Authorized Official
Title or Position	:	OWNER
Name	:	HUGH C SIMMONS
Credential	:	LCSW
Telephone Number	:	347-489-5482

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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