MEDICARE: MRS. KYLA BRISTOL GOLDEN LCPC

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	101Y00000X	Counselor	LC5073	MD

General Provider Information

NPI Number	:	1942637475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYLA BRISTOL GOLDEN LCPC

Provider Business Mailing Address
First Line	:	3919 NATIONAL DR STE 200
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1184
Country	:	US
Telephone Number	:	301-476-8525
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 NATIONAL DR STE 200
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1184
Country	:	US
Telephone Number	:	301-476-8525
Fax Number	:

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

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	02/27/2023

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