MEDICARE: MS. KAREN KRISTINE NEWKIRK LCPC

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	LCPC-4477	ID
2	101YP2500X	Professional Counselor	LCPC-4477	ID
3	101YM0800X	Mental Health Counselor	LCPC-4477	ID

General Provider Information

NPI Number	:	1194040444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN KRISTINE NEWKIRK LCPC

Provider Business Mailing Address
First Line	:	775 YELLOWSTONE AVE
Second Line	:	PMB 320
City	:	POCATELLO
State	:	ID
Zip	:	83201-4406
Country	:	US
Telephone Number	:	208-241-5533
Fax Number	:	208-232-4944

Provider Business Practice Location Address
First Line	:	3350 W AMERICANA TER
Second Line	:	SUITE 300
City	:	BOISE
State	:	ID
Zip	:	83706-2521
Country	:	US
Telephone Number	:	208-343-1113
Fax Number	:	208-232-4944

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

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	06/01/2010

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