Healthcare Provider Details

I. General information

NPI: 1033277769
Provider Name (Legal Business Name): TARA D KUCHINSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AIRPORT RD
TERRELL TX
75160-4302
US

IV. Provider business mailing address

400 AIRPORT RD PO BOX 747
TERRELL TX
75160-4302
US

V. Phone/Fax

Practice location:
  • Phone: 972-524-4159
  • Fax: 972-563-5321
Mailing address:
  • Phone: 972-524-4159
  • Fax: 972-563-5321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62431
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: