MEDICARE: KIMBERLY R MASONI LPC-A

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	87576	TX

General Provider Information

NPI Number	:	1184361487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R MASONI LPC-A

Provider Business Mailing Address
First Line	:	1101 TUDOR HOUSE RD
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-3000
Country	:	US
Telephone Number	:	512-573-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	3818 SPICEWOOD SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8968
Country	:	US
Telephone Number	:	512-573-2098
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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Directions to “ KIMBERLY R MASONI LPC-A” Practice Location

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