MEDICARE: KATHRYN FENSTER LAC

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	LAC-20501	AZ

General Provider Information

NPI Number	:	1912668823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN FENSTER LAC

Provider Business Mailing Address
First Line	:	3009 N WEST ST FL 2
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-3444
Country	:	US
Telephone Number	:	928-719-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	3009 N WEST ST FL 2
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-3444
Country	:	US
Telephone Number	:	928-719-4009
Fax Number	:

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

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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