MEDICARE: MRS. KIA JEANINE HART MA, 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	101YP2500X	Professional Counselor	19323	TX

General Provider Information

NPI Number	:	1699914416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIA JEANINE HART MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 371113
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79937-1113
Country	:	US
Telephone Number	:	915-594-8685
Fax Number	:	866-596-6125

Provider Business Practice Location Address
First Line	:	10761 PEBBLE HILLS BLVD
Second Line	:	STE F
City	:	EL PASO
State	:	TX
Zip	:	79935-2037
Country	:	US
Telephone Number	:	915-594-8685
Fax Number	:	866-596-6125

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

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	01/06/2012

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