MEDICARE: MS. JOYCE ELLEN KINNAMAN L.P.C.

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	101YP2500X	Professional Counselor	4334	CO

General Provider Information

NPI Number	:	1073823050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOYCE ELLEN KINNAMAN L.P.C.

Provider Business Mailing Address
First Line	:	16832 BUFFALO VALLEY PATH
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7172
Country	:	US
Telephone Number	:	719-331-5063
Fax Number	:	719-481-0304

Provider Business Practice Location Address
First Line	:	4785 GRANBY CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3131
Country	:	US
Telephone Number	:	719-331-5063
Fax Number	:	719-481-0304

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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