MEDICARE: MS. LAURA FURST

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	E1300562	OH
2	101YP2500X	Professional Counselor	C1300562	OH

General Provider Information

NPI Number	:	1366863094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA FURST

Provider Business Mailing Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:

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

Provider Enumeration Date	:	12/24/2013
Last Update Date	:	01/30/2017

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