MEDICARE: MS. LAURA KACHINKO SHELY M.A., LMFT-A

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	106H00000X	Marriage & Family Therapist	201720	TX

General Provider Information

NPI Number	:	1023389509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA KACHINKO SHELY M.A., LMFT-A

Provider Business Mailing Address
First Line	:	5619 GRAPE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	713-851-7932
Fax Number	:

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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