MEDICARE: MS. BRIDGETTE MARIE BUCHANAN-STARKS 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
1	101YM0800X	Mental Health Counselor	20030	TX
2	101YP2500X	Professional Counselor	20030	TX

General Provider Information

NPI Number	:	1427267954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRIDGETTE MARIE BUCHANAN-STARKS LPC

Provider Business Mailing Address
First Line	:	7915 DEER MEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2712
Country	:	US
Telephone Number	:	713-729-0310
Fax Number	:	713-729-0310

Provider Business Practice Location Address
First Line	:	7915 DEER MEADOW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2712
Country	:	US
Telephone Number	:	713-729-0310
Fax Number	:	713-729-0310

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/25/2007

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