MEDICARE: KIRSTEN KOLEA LAUREL

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	101YM0800X	Mental Health Counselor
2	221700000X	Art Therapist

General Provider Information

NPI Number	:	1366213977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN KOLEA LAUREL

Provider Business Mailing Address
First Line	:	3225 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2257
Country	:	US
Telephone Number	:	425-655-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 MCLEOD DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2257
Country	:	US
Telephone Number	:	425-655-7151
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	05/11/2026

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Directions to “ KIRSTEN KOLEA LAUREL ” Practice Location

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