MEDICARE: KYLIE CHAFFIN LMHC

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	6401015103	MI
2	101YM0800X	Mental Health Counselor	LH60799157	WA
3	101YP2500X	Professional Counselor	MC60669894	WA

General Provider Information

NPI Number	:	1396281903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE CHAFFIN LMHC

Provider Business Mailing Address
First Line	:	9921 N NEVADA ST STE 103
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-1145
Country	:	US
Telephone Number	:	509-581-2690
Fax Number	:	509-593-4676

Provider Business Practice Location Address
First Line	:	9921 N NEVADA ST STE 103
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-1145
Country	:	US
Telephone Number	:	509-581-2690
Fax Number	:	509-593-4676

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

Provider Enumeration Date	:	01/07/2017
Last Update Date	:	04/30/2024

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