MEDICARE: KAGAN COUNSELING, LLC

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	302R00000X	Health Maintenance Organization	12667	CO

General Provider Information

NPI Number	:	1811436330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAGAN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1776 S JACKSON ST STE 412
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3807
Country	:	US
Telephone Number	:	757-650-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 S JACKSON ST STE 412
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3807
Country	:	US
Telephone Number	:	757-650-9623
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	BECKY KAGAN
Credential	:
Telephone Number	:	757-650-9623

Provider Enumeration Date	:	02/16/2017
Last Update Date	:	02/16/2017

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