MEDICARE: MRS. KIMBERLY MAE LUNNING M. ED. COUNSELING

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	MC 60148468	WA

General Provider Information

NPI Number	:	1386053528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MAE LUNNING M. ED. COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 3181
Second Line	:
City	:	UNION GAP
State	:	WA
Zip	:	98903-0181
Country	:	US
Telephone Number	:	509-307-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 RIVERSIDE RD
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98901-8538
Country	:	US
Telephone Number	:	509-307-0354
Fax Number	:

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

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/12/2014

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