MEDICARE: KAETLYN MCKEE ROBERTS LPC

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	2019009397	MO

General Provider Information

NPI Number	:	1639639966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAETLYN MCKEE ROBERTS LPC

Provider Business Mailing Address
First Line	:	324 COMANCHE RD
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-9319
Country	:	US
Telephone Number	:	573-723-1219
Fax Number	:	573-562-6121

Provider Business Practice Location Address
First Line	:	5896 OSAGE BEACH PKWY STE 3
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3040
Country	:	US
Telephone Number	:	573-723-1219
Fax Number	:	573-562-6121

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

Provider Enumeration Date	:	03/22/2019
Last Update Date	:	05/03/2024

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