MEDICARE: PAULA A LYSSY M.A.

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	103TS0200X	School Psychologist	33063	TX
2	101YP2500X	Professional Counselor	18469	TX

General Provider Information

NPI Number	:	1215756846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA A LYSSY M.A.

Provider Business Mailing Address
First Line	:	PO BOX 473
Second Line	:
City	:	FALLS CITY
State	:	TX
Zip	:	78113-0473
Country	:	US
Telephone Number	:	830-583-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	10434 US HIGHWAY 181 S
Second Line	:
City	:	FALLS CITY
State	:	TX
Zip	:	78113-3000
Country	:	US
Telephone Number	:	830-583-4426
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/18/2024

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Directions to “ PAULA A LYSSY M.A.” Practice Location

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