MEDICARE: KIANA KURZYNOWSKI LPC LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	171M00000X	Case Manager/Care Coordinator
3	251V00000X	Voluntary or Charitable Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C5862	OTHER	OR	LPC LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821683749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIANA KURZYNOWSKI LPC LLC

Provider Business Mailing Address
First Line	:	63427 DESCHUTES MARKET RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-8813
Country	:	US
Telephone Number	:	808-633-1386
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 NW FRANKLIN AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2905
Country	:	US
Telephone Number	:	541-610-8826
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KOLENE KIANA KURZYNOWSKI
Credential	:	LPC
Telephone Number	:	808-633-1386

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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