MEDICARE: MARILYN KISSINGER PH.D.

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	103TC1900X	Counseling Psychologist	32601	TX

General Provider Information

NPI Number	:	1245418037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN KISSINGER PH.D.

Provider Business Mailing Address
First Line	:	6370 LBJ FWY
Second Line	:	SUITE 276
City	:	DALLAS
State	:	TX
Zip	:	75240-6459
Country	:	US
Telephone Number	:	972-788-9201
Fax Number	:	972-788-0061

Provider Business Practice Location Address
First Line	:	6370 LBJ FWY
Second Line	:	SUITE 276
City	:	DALLAS
State	:	TX
Zip	:	75240-6459
Country	:	US
Telephone Number	:	972-788-9201
Fax Number	:	972-788-0061

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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