MEDICARE: MS. COLEEN K ESSARY MA 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	101YP2500X	Professional Counselor	LPC15704	TX

General Provider Information

NPI Number	:	1477601888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLEEN K ESSARY MA LPC

Provider Business Mailing Address
First Line	:	110 KRUPKA ST
Second Line	:
City	:	COLUMBUS
State	:	TX
Zip	:	78934-2013
Country	:	US
Telephone Number	:	361-857-4510
Fax Number	:	979-484-8104

Provider Business Practice Location Address
First Line	:	110 KRUPKA ST
Second Line	:
City	:	COLUMBUS
State	:	TX
Zip	:	78934-2013
Country	:	US
Telephone Number	:	361-857-4510
Fax Number	:	979-484-8104

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/08/2023

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