=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194223594
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARSHA LYNN ROMANOWSKI LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2018
-----------------------------------------------------
Last Update Date | 01/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9741 PRESTON RD STE 208
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75033-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-943-0400
-----------------------------------------------------
Fax | 972-943-0500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 SENECA PL
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-334-9937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 62873
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------