MEDICARE: AUSTIN B KELBAUGH 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	2025002181	MO

General Provider Information

NPI Number	:	1700515095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN B KELBAUGH LPC

Provider Business Mailing Address
First Line	:	1864 S KENTWOOD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2323
Country	:	US
Telephone Number	:	417-869-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 S KENTWOOD AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2323
Country	:	US
Telephone Number	:	417-869-8400
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	04/07/2025

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