MEDICARE: MRS. JUDITH L LESTER M.A. IN COUNSELING

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	LMFT 702	TX

General Provider Information

NPI Number	:	1720165855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH L LESTER M.A. IN COUNSELING

Provider Business Mailing Address
First Line	:	4200 S HULEN ST
Second Line	:	SUITE 686
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4914
Country	:	US
Telephone Number	:	817-370-2636
Fax Number	:	817-732-3258

Provider Business Practice Location Address
First Line	:	4200 S HULEN ST
Second Line	:	SUITE 686
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4914
Country	:	US
Telephone Number	:	817-370-2636
Fax Number	:	817-732-3258

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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