MEDICARE: MR. KENNETH MICHAEL LOUD MS, CGC

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

General Provider Information

NPI Number	:	1083619290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH MICHAEL LOUD MS, CGC

Provider Business Mailing Address
First Line	:	5218 MICHAELS WAY
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4675
Country	:	US
Telephone Number	:	770-592-7451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2165 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5307
Country	:	US
Telephone Number	:	404-778-8553
Fax Number	:	404-778-8559

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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