MEDICARE: KPB CONSULTING, LLC

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

General Provider Information

NPI Number	:	1285257774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPB CONSULTING, LLC

Provider Business Mailing Address
First Line	:	479 BIG VALLEY DR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9359
Country	:	US
Telephone Number	:	970-507-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 CORNERSTONE DR # 208
Second Line	:
City	:	PAGOSA SPGS
State	:	CO
Zip	:	81147-8156
Country	:	US
Telephone Number	:	970-507-0436
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY PIPKINS-BURT
Credential	:
Telephone Number	:	970-507-0436

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	05/19/2020

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