MEDICARE: KIMBERLY K HANDWERK MA, LPC

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	6401011817	MI

General Provider Information

NPI Number	:	1194062695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY K HANDWERK MA, LPC

Provider Business Mailing Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2386
Country	:	US
Telephone Number	:	231-935-6880
Fax Number	:	231-935-6873

Provider Business Practice Location Address
First Line	:	1105 SIXTH ST
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2386
Country	:	US
Telephone Number	:	231-935-6880
Fax Number	:	231-935-6873

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

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	06/30/2021

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