MEDICARE: INDEPENDENCE BLVD COUNSELING SERVICES

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	:	1659536431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE BLVD COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	1701 WESTWIND DR
Second Line	:	SUITE 208
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-3048
Country	:	US
Telephone Number	:	661-859-0628
Fax Number	:	661-859-0629

Provider Business Practice Location Address
First Line	:	1701 WESTWIND DR
Second Line	:	SUITE 208
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-3048
Country	:	US
Telephone Number	:	661-859-0628
Fax Number	:	661-859-0629

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	CAROLYNE KRALL-CATRON
Credential	:	PH.D.
Telephone Number	:	661-859-0628

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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