MEDICARE: KATIE WINER 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	65809	TX

General Provider Information

NPI Number	:	1760819346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE WINER MA, LPC

Provider Business Mailing Address
First Line	:	205 WILD BASIN RD STE 2B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-3304
Country	:	US
Telephone Number	:	512-650-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 WILD BASIN RD STE 2B
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-3304
Country	:	US
Telephone Number	:	512-650-8118
Fax Number	:	512-582-8431

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

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	04/28/2020

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