MEDICARE: KATHRYN MARIE LUSCRI I M.ED., 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	16336	TX

General Provider Information

NPI Number	:	1720195365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN MARIE LUSCRI I M.ED., LPC

Provider Business Mailing Address
First Line	:	6301 GASTON AVE
Second Line	:	SUITE 824
City	:	DALLAS
State	:	TX
Zip	:	75214-3922
Country	:	US
Telephone Number	:	214-893-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 GASTON AVE
Second Line	:	SUITE 824
City	:	DALLAS
State	:	TX
Zip	:	75214-3922
Country	:	US
Telephone Number	:	214-893-0972
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/14/2010

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