MEDICARE: CAROL MODDELMOG LCMFT

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	106H00000X	Marriage & Family Therapist	194	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588603328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MODDELMOG LCMFT

Provider Business Mailing Address
First Line	:	1700 E IRON AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3401
Country	:	US
Telephone Number	:	785-577-9802
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 E IRON AVE
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-3401
Country	:	US
Telephone Number	:	785-577-9802
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/27/2026

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