MEDICARE: DINAH BOSTIC

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	101Y00000X	Counselor	77813	TX
2	101Y00000X	Counselor	3777	TN

General Provider Information

NPI Number	:	1659891679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINAH BOSTIC

Provider Business Mailing Address
First Line	:	2600 S LOOP W STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2606
Country	:	US
Telephone Number	:	832-830-8662
Fax Number	:	713-714-8627

Provider Business Practice Location Address
First Line	:	2600 S LOOP W STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2606
Country	:	US
Telephone Number	:	832-830-8662
Fax Number	:	713-714-8627

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	07/21/2022

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Directions to “ DINAH BOSTIC ” Practice Location

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