MEDICARE: KELLY P MUCHA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	103K00000X	Behavior Analyst
4	104100000X	Social Worker
5	1041C0700X	Clinical Social Worker
6	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1700172830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY P MUCHA LCSW

Provider Business Mailing Address
First Line	:	4524 WHITCOMB ST
Second Line	:
City	:	GARY
State	:	IN
Zip	:	46408-3506
Country	:	US
Telephone Number	:	219-613-0332
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 US HIGHWAY 41
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-1361
Country	:	US
Telephone Number	:	219-613-0332
Fax Number	:

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	04/23/2016

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Directions to “ KELLY P MUCHA LCSW” Practice Location

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