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NPI Code Detail

MEDICARE: MS. CAROL LYNN KETCHUM LPC

MEDICARE: MS. CAROL LYNN KETCHUM 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
1101YP2500XProfessional CounselorLPC11142AZ

General Provider Information

NPI Number : 1952320335
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL LYNN KETCHUM LPC
Provider Business Mailing Address
First Line : 1 W ELLIOT RD
Second Line : SUITE 101
City : TEMPE
State : AZ
Zip : 85284-1310
Country : US
Telephone Number : 480-694-8979
Fax Number :
Provider Business Practice Location Address
First Line : 1 W ELLIOT RD
Second Line : SUITE 101
City : TEMPE
State : AZ
Zip : 85284-1310
Country : US
Telephone Number : 480-694-8979
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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