MEDICARE: DR. CAROL J. KERSHAW ED.D.

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	103T00000X	Psychologist	22130	TX

General Provider Information

NPI Number	:	1255358206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL J. KERSHAW ED.D.

Provider Business Mailing Address
First Line	:	3400 BISSONNET ST
Second Line	:	SUITE 267
City	:	HOUSTON
State	:	TX
Zip	:	77005-2155
Country	:	US
Telephone Number	:	713-529-4588
Fax Number	:	713-529-4589

Provider Business Practice Location Address
First Line	:	3400 BISSONNET ST
Second Line	:	SUITE 267
City	:	HOUSTON
State	:	TX
Zip	:	77005-2155
Country	:	US
Telephone Number	:	713-529-4588
Fax Number	:	713-529-4589

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/08/2007

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