MEDICARE: MS. KAMALA JEAN KELTON LCMHC

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	068-0000359	VT

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	:	1649218439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAMALA JEAN KELTON LCMHC

Provider Business Mailing Address
First Line	:	55 S MAIN ST
Second Line	:	BOX 4
City	:	WATERBURY
State	:	VT
Zip	:	05676-1556
Country	:	US
Telephone Number	:	802-244-7937
Fax Number	:	802-244-7937

Provider Business Practice Location Address
First Line	:	55 S MAIN ST
Second Line	:	BOX 4
City	:	WATERBURY
State	:	VT
Zip	:	05676-1556
Country	:	US
Telephone Number	:	802-244-7937
Fax Number	:	802-244-7937

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/09/2007

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