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General NPI Number Information
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NPI Number | 1689335895
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Entity Type | Individual
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Provider Name | THERESA FUSARO LPC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 712 S MAY ST
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City | MADISONVILLE
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State | TX
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Zip | 77864-2564
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Country | US
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Telephone | 936-348-3418
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Fax | 936-349-0656
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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E STE 100
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2600
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Country | US
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Telephone | 979-383-2340
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Fax | 979-260-9390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13014
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License Number State | TX
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