MEDICARE: DR. KAREN ELAINE KUDLAC PHD

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	13325	TX
2	106H00000X	Marriage & Family Therapist	004660022582	TX

General Provider Information

NPI Number	:	1134335730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN ELAINE KUDLAC PHD

Provider Business Mailing Address
First Line	:	914 N LOCUST ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2954
Country	:	US
Telephone Number	:	940-387-6250
Fax Number	:	940-387-6274

Provider Business Practice Location Address
First Line	:	914 N LOCUST ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-2954
Country	:	US
Telephone Number	:	940-387-6250
Fax Number	:	940-387-6274

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/20/2007

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