MEDICARE: KIMBERLY ANN MUNDY M.A., LPC, ALPS

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	1245	WV

General Provider Information

NPI Number	:	1619588100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN MUNDY M.A., LPC, ALPS

Provider Business Mailing Address
First Line	:	232 CAPITOL ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-2234
Country	:	US
Telephone Number	:	304-807-0029
Fax Number	:	888-511-3073

Provider Business Practice Location Address
First Line	:	232 CAPITOL ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-2234
Country	:	US
Telephone Number	:	304-807-0029
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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