MEDICARE: AGNESE K KELETE

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	:	1922132380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNESE K KELETE

Provider Business Mailing Address
First Line	:	1046 W TAYLOR ST
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1815
Country	:	US
Telephone Number	:	408-297-7354
Fax Number	:	408-297-7354

Provider Business Practice Location Address
First Line	:	1046 W TAYLOR ST
Second Line	:	SUITE 100
City	:	SAN JOSE
State	:	CA
Zip	:	95126-1815
Country	:	US
Telephone Number	:	408-297-7354
Fax Number	:	408-297-7354

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/08/2007

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Directions to “ AGNESE K KELETE ” Practice Location

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