MEDICARE: PA HOUA KIATOUKAYSI 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	6036-125	WI

General Provider Information

NPI Number	:	1689928806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PA HOUA KIATOUKAYSI LPC

Provider Business Mailing Address
First Line	:	2270 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-4710
Country	:	US
Telephone Number	:	920-733-2065
Fax Number	:

Provider Business Practice Location Address
First Line	:	2270 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-4710
Country	:	US
Telephone Number	:	920-733-2065
Fax Number	:

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

Provider Enumeration Date	:	11/09/2012
Last Update Date	:	02/17/2023

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