MEDICARE: KB MIRACLES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336762806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KB MIRACLES LLC

Provider Business Mailing Address
First Line	:	4145 PINELLA CIR APT 364
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6744
Country	:	US
Telephone Number	:	386-795-4169
Fax Number	:

Provider Business Practice Location Address
First Line	:	4145 PINELLA CIR APT 364
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-6744
Country	:	US
Telephone Number	:	386-795-4169
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERYN WINSLOW
Credential	:	LMHC, MS
Telephone Number	:	386-795-4169

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	05/20/2020

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