MEDICARE: TERESA ROWE M.A. EDUPSY

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1871016642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ROWE M.A. EDUPSY

Provider Business Mailing Address
First Line	:	PO BOX 820772
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77282-0772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13411 BRIAR FOREST DR APT 4043
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2666
Country	:	US
Telephone Number	:	713-298-5373
Fax Number	:

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	07/24/2017

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