MEDICARE: KYRA N VUOLO LGPC

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	101YM0800X	Mental Health Counselor	LGP9875	MD

General Provider Information

NPI Number	:	1124678040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA N VUOLO LGPC

Provider Business Mailing Address
First Line	:	1600 CRAIN HWY S STE 503
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-6443
Country	:	US
Telephone Number	:	443-354-1200
Fax Number	:	410-553-0019

Provider Business Practice Location Address
First Line	:	1600 CRAIN HWY S STE 503
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-6443
Country	:	US
Telephone Number	:	443-354-1200
Fax Number	:	410-553-0019

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

Provider Enumeration Date	:	09/12/2019
Last Update Date	:	09/12/2019

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