MEDICARE: MRS. KERRI CHRISTINA KHATIB LAC,LBSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAC526	KS
2	104100000X	Social Worker	LBSW4079	KS

General Provider Information

NPI Number	:	1164847927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRI CHRISTINA KHATIB LAC,LBSW

Provider Business Mailing Address
First Line	:	1625 SAINT ANDREWS DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-1701
Country	:	US
Telephone Number	:	785-423-0007
Fax Number	:	785-296-0256

Provider Business Practice Location Address
First Line	:	1625 SAINT ANDREWS DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-1701
Country	:	US
Telephone Number	:	785-423-0007
Fax Number	:	785-296-0256

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

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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