MEDICARE: B.A.S.I.C. REALITY

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1174668354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.A.S.I.C. REALITY

Provider Business Mailing Address
First Line	:	2908 MCKINNEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2431
Country	:	US
Telephone Number	:	214-965-0980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2908 MCKINNEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2431
Country	:	US
Telephone Number	:	214-965-0980
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. CATHY S LUCAS
Credential	:	PH.D.
Telephone Number	:	214-965-0980

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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