MEDICARE: KMM MENTAL HEALTH COUNSELING, PLLC

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	:	1649125774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMM MENTAL HEALTH COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	242 MAIN ST # 345
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-2732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 MAIN ST # 345
Second Line	:
City	:	BEACON
State	:	NY
Zip	:	12508-2732
Country	:	US
Telephone Number	:	917-740-7592
Fax Number	:

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	KAITLIN MASOPUST
Credential	:	LMHC
Telephone Number	:	917-740-7592

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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