MEDICARE: KIM KLUGER-BELL MFT

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	106H00000X	Marriage & Family Therapist	860	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	860	OTHER	CO	MARRIAGE AND FAMILY THERAPIST

General Provider Information

NPI Number	:	1265557805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM KLUGER-BELL MFT

Provider Business Mailing Address
First Line	:	2769 IRIS AVE
Second Line	:	SUITE 110
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-517-3702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2769 IRIS AVE
Second Line	:	SUITE 110
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-517-3702
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	06/02/2011

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