MEDICARE: MS. LAURI B CUSICK 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	14441	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588616759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURI B CUSICK LPC

Provider Business Mailing Address
First Line	:	1008 ELM POINTE
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-9080
Country	:	US
Telephone Number	:	713-824-0474
Fax Number	:	281-557-7596

Provider Business Practice Location Address
First Line	:	1008 ELM POINTE
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-9080
Country	:	US
Telephone Number	:	713-824-0474
Fax Number	:	281-557-7596

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	05/16/2008

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