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NPI Code Detail

MEDICARE: SHANA KOSTICK

MEDICARE: SHANA KOSTICK
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
1101YP2500XProfessional Counselor64607TX

General Provider Information

NPI Number : 1861634305
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANA KOSTICK
Provider Business Mailing Address
First Line : 4001 W 15TH ST STE 465
Second Line :
City : PLANO
State : TX
Zip : 75093-5845
Country : US
Telephone Number : 469-246-1311
Fax Number : 972-964-9775
Provider Business Practice Location Address
First Line : 4001 W 15TH ST STE 465
Second Line :
City : PLANO
State : TX
Zip : 75093-5845
Country : US
Telephone Number : 469-246-1311
Fax Number : 972-964-9775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2009
Last Update Date : 03/30/2009

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Directions to “ SHANA KOSTICK ” Practice Location

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