MEDICARE: NATALYE KIRKLAND

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	PC014848	PA

General Provider Information

NPI Number	:	1104548023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALYE KIRKLAND

Provider Business Mailing Address
First Line	:	1303 E JOHNSON ST # 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1039
Country	:	US
Telephone Number	:	267-456-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 E JOHNSON ST # 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1039
Country	:	US
Telephone Number	:	267-456-7782
Fax Number	:

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

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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Directions to “ NATALYE KIRKLAND ” Practice Location

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