MEDICARE: KALI MARIE KENAR 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	LPC-17935	AZ

General Provider Information

NPI Number	:	1871149468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALI MARIE KENAR LPC

Provider Business Mailing Address
First Line	:	14015 N 94TH ST APT 3051
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-7703
Country	:	US
Telephone Number	:	602-621-6619
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 W CAREFREE HWY STE 102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-9302
Country	:	US
Telephone Number	:	623-432-8066
Fax Number	:

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

Provider Enumeration Date	:	08/10/2019
Last Update Date	:	08/10/2019

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