MEDICARE: LORI MARIE MONDSHINE 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	84127	TX

General Provider Information

NPI Number	:	1588355481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MARIE MONDSHINE LPC

Provider Business Mailing Address
First Line	:	11403 CREEKWOOD HILLS LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5966
Country	:	US
Telephone Number	:	281-794-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 BOROUGH PARK DR STE 220
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3564
Country	:	US
Telephone Number	:	936-777-3940
Fax Number	:

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

Provider Enumeration Date	:	05/19/2023
Last Update Date	:	05/19/2023

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