MEDICARE: AHNISA KLU LPCC

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	LPCC.0022970	CO
2	101YM0800X	Mental Health Counselor	LPCC.0022970	CO

General Provider Information

NPI Number	:	1447058011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHNISA KLU LPCC

Provider Business Mailing Address
First Line	:	8250 E HARVARD AVE APT 4202
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 S BELLAIRE ST STE 909
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80222-4333
Country	:	US
Telephone Number	:	303-476-1974
Fax Number	:

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

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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