MEDICARE: KELLY A. PIPKINS-BURT

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	0013727	CO

General Provider Information

NPI Number	:	1679045173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY A. PIPKINS-BURT

Provider Business Mailing Address
First Line	:	479 BIG VALLEY DR
Second Line	:
City	:	PAGOSA SPRINGS
State	:	CO
Zip	:	81147-9359
Country	:	US
Telephone Number	:	970-507-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 CORNERSTONE DR # 208
Second Line	:
City	:	PAGOSA SPGS
State	:	CO
Zip	:	81147-8114
Country	:	US
Telephone Number	:	970-507-0436
Fax Number	:

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	07/06/2021

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