MEDICARE: PAMELA KESEE-WYRE

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
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	K0412130908	CA

General Provider Information

NPI Number	:	1710017728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA KESEE-WYRE

Provider Business Mailing Address
First Line	:	310 HARRIS AVE
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3249
Country	:	US
Telephone Number	:	916-649-6793
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 HARRIS AVE
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3249
Country	:	US
Telephone Number	:	916-649-6793
Fax Number	:

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/14/2022

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