MEDICARE: DR. LISA S WECHSLER PH.D.

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	103TC1900X	Counseling Psychologist	14663	TX

General Provider Information

NPI Number	:	1073671152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA S WECHSLER PH.D.

Provider Business Mailing Address
First Line	:	17304 PRESTON RD
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75252-5618
Country	:	US
Telephone Number	:	214-438-3838
Fax Number	:	972-733-6809

Provider Business Practice Location Address
First Line	:	17304 PRESTON RD
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75252-5618
Country	:	US
Telephone Number	:	214-438-3838
Fax Number	:	972-733-6809

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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