MEDICARE: KAITLYN LANAE CARR

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1215571856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN LANAE CARR

Provider Business Mailing Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	719-423-7428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	719-423-7428
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	10/04/2022

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Directions to “ KAITLYN LANAE CARR ” Practice Location

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