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NPI Code Detail

MEDICARE: KASEY ANN POLK LPC

MEDICARE: KASEY ANN POLK 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 Counselor81063TX

General Provider Information

NPI Number : 1518684331
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY ANN POLK LPC
Provider Business Mailing Address
First Line : 4400 MEMORIAL DR APT 1201
Second Line :
City : HOUSTON
State : TX
Zip : 77007-7344
Country : US
Telephone Number : 832-226-2270
Fax Number :
Provider Business Practice Location Address
First Line : 4400 MEMORIAL DR APT 1201
Second Line :
City : HOUSTON
State : TX
Zip : 77007-7344
Country : US
Telephone Number : 832-226-2270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2022
Last Update Date : 10/24/2022

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Directions to “ KASEY ANN POLK LPC” Practice Location

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