MEDICARE: SHARI PORTER JUNG LCSW, LMFT, CGP

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	1041C0700X	Clinical Social Worker	O1587	TX
2	106H00000X	Marriage & Family Therapist	2425	TX

General Provider Information

NPI Number	:	1245529981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI PORTER JUNG LCSW, LMFT, CGP

Provider Business Mailing Address
First Line	:	5210 MCKINNEY AVE # 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3357
Country	:	US
Telephone Number	:	214-780-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 MCKINNEY AVE # 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3357
Country	:	US
Telephone Number	:	214-780-0220
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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