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NPI Code Detail

MEDICARE: KANDIS JUNE KANINE LMHA, MHP

MEDICARE: KANDIS JUNE KANINE LMHA, MHP
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
1101YP2500XProfessional Counselor6401004169MI
2101YM0800XMental Health CounselorCG60520790WA
3101YM0800XMental Health CounselorMC61036475WA

General Provider Information

NPI Number : 1215994694
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANDIS JUNE KANINE LMHA, MHP
Provider Business Mailing Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 630-330-9044
Fax Number : 360-736-3139
Provider Business Practice Location Address
First Line : 2428 W REYNOLDS AVE
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-4554
Country : US
Telephone Number : 360-330-9044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 02/25/2022

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