Healthcare Provider Details

I. General information

NPI: 1609205160
Provider Name (Legal Business Name): KAITLIN MEADE M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N 11TH ST
SENECA KS
66538-1713
US

IV. Provider business mailing address

PO BOX 186
CENTRALIA KS
66415-0186
US

V. Phone/Fax

Practice location:
  • Phone: 785-336-2173
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2443
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: