MEDICARE: KRISTIN L VOLCK LPC

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	101YM0800X	Mental Health Counselor	LPC 70960	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FL LMHC 5370	OTHER	FL	LMHC FL
2	TX LPC 70960	OTHER	TX	TX LPC

General Provider Information

NPI Number	:	1326033101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN L VOLCK LPC

Provider Business Mailing Address
First Line	:	1881 AIRPORT FWY APT 1111
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76040-4065
Country	:	US
Telephone Number	:	850-361-9404
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 LONG PRAIRIE RD
Second Line	:	STE 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2718
Country	:	US
Telephone Number	:	972-350-0225
Fax Number	:

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	01/27/2014

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