MEDICARE: KM INTEGRATED HEALTH SERVICES 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1912670316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KM INTEGRATED HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	3850 E BASELINE RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4403
Country	:	US
Telephone Number	:	480-687-7014
Fax Number	:	480-687-7845

Provider Business Practice Location Address
First Line	:	3850 E BASELINE RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4403
Country	:	US
Telephone Number	:	480-687-7014
Fax Number	:	480-687-7845

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KATE NDUDI EBEA
Credential	:
Telephone Number	:	480-270-1418

Provider Enumeration Date	:	07/30/2021
Last Update Date	:	03/03/2026

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