MEDICARE: NANCY KOLO 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	12946	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	128151	OTHER	TX	VALUE OPTIONS

General Provider Information

NPI Number	:	1417014630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KOLO LPC

Provider Business Mailing Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 207
City	:	DALLAS
State	:	TX
Zip	:	75219-5426
Country	:	US
Telephone Number	:	972-948-9155
Fax Number	:	214-443-0322

Provider Business Practice Location Address
First Line	:	3131 TURTLE CREEK BLVD
Second Line	:	SUITE 207
City	:	DALLAS
State	:	TX
Zip	:	75219-5426
Country	:	US
Telephone Number	:	972-948-9155
Fax Number	:	214-443-0322

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/09/2007

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Directions to “ NANCY KOLO LPC” Practice Location

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