MEDICARE: KATYNA CHRISTIAN 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	19430	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7247LC	OTHER	TX	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1477688521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATYNA CHRISTIAN LPC

Provider Business Mailing Address
First Line	:	PO BOX 2148
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75013-0038
Country	:	US
Telephone Number	:	214-288-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 CHARLESTON DR
Second Line	:	A
City	:	ALLEN
State	:	TX
Zip	:	75002-0913
Country	:	US
Telephone Number	:	214-288-8878
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/09/2007

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