MEDICARE: KATHERINE D MUNCEY

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	SW092517632	WV

General Provider Information

NPI Number	:	1366318503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE D MUNCEY

Provider Business Mailing Address
First Line	:	209 WASHINGTON ST W STE 200
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-2348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 KANAWHA BLVD E
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-2323
Country	:	US
Telephone Number	:	304-539-0342
Fax Number	:

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

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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Directions to “ KATHERINE D MUNCEY ” Practice Location

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