MEDICARE: MR. KENNETH EUGENE EUBANK JR.

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	101YP2500X	Professional Counselor	64936	TX

General Provider Information

NPI Number	:	1124457346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH EUGENE EUBANK JR.

Provider Business Mailing Address
First Line	:	2001W. PLANO PARKWAY
Second Line	:	SUITE 2300
City	:	PLANO
State	:	TX
Zip	:	75075
Country	:	US
Telephone Number	:	972-422-8383
Fax Number	:	972-422-2711

Provider Business Practice Location Address
First Line	:	2001 W PLANO PKWY
Second Line	:	SUITE 2300
City	:	PLANO
State	:	TX
Zip	:	75075-8601
Country	:	US
Telephone Number	:	972-422-8383
Fax Number	:	972-422-2711

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

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	11/07/2013

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