MEDICARE: MS. KATHLEEN KALOUDIS LCMHC

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	101Y00000X	Counselor	17837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821187261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN KALOUDIS LCMHC

Provider Business Mailing Address
First Line	:	PO BOX 71051
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84171-0051
Country	:	US
Telephone Number	:	801-201-7050
Fax Number	:	801-880-1508

Provider Business Practice Location Address
First Line	:	7105 S HIGHLAND DR STE 202
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7321
Country	:	US
Telephone Number	:	801-201-7050
Fax Number	:	801-880-1508

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/10/2022

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