MEDICARE: MRS. CATHLYN MARGOT KLEMMENSEN

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

General Provider Information

NPI Number	:	1558511972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHLYN MARGOT KLEMMENSEN

Provider Business Mailing Address
First Line	:	6915 ROUNDROCK CT
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-8233
Country	:	US
Telephone Number	:	317-837-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	2345 S LYNHURST DR STE 107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46241-5100
Country	:	US
Telephone Number	:	317-997-4344
Fax Number	:

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

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	09/22/2008

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