MEDICARE: LISA MARIE MORIN M.A., L.P.C.

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	66986	TX

General Provider Information

NPI Number	:	1679826879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE MORIN M.A., L.P.C.

Provider Business Mailing Address
First Line	:	167 GEORGIAN DRIVE
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019
Country	:	US
Telephone Number	:	469-583-4568
Fax Number	:	972-745-4542

Provider Business Practice Location Address
First Line	:	600 S DENTON TAP RD
Second Line	:
City	:	COPPELL
State	:	TX
Zip	:	75019-4533
Country	:	US
Telephone Number	:	469-583-4568
Fax Number	:	972-745-4542

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

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	10/25/2012

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