MEDICARE: KATHY L PARADISE 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	16466	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16466	OTHER	TX	LIC PROFFESIONAL COUNSELO

General Provider Information

NPI Number	:	1790973345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY L PARADISE LPC

Provider Business Mailing Address
First Line	:	3031 I H 10 W
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5159
Country	:	US
Telephone Number	:	210-731-1300
Fax Number	:	210-731-1310

Provider Business Practice Location Address
First Line	:	806 S ZARZAMORA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-5362
Country	:	US
Telephone Number	:	210-731-1300
Fax Number	:	210-434-0716

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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