MEDICARE: MARY KINES LPC-ASSOCIATE

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	95077	TX

General Provider Information

NPI Number	:	1174250427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KINES LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	215 N MOORE RD APT 1124
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5285
Country	:	US
Telephone Number	:	940-290-1916
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 N MOORE RD APT 1124
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-5285
Country	:	US
Telephone Number	:	940-290-1916
Fax Number	:

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

Provider Enumeration Date	:	08/05/2022
Last Update Date	:	02/18/2026

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