MEDICARE: THOMAS EDWARD KERSHAW LCSW

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	1041C0700X	Clinical Social Worker	31966	TX

General Provider Information

NPI Number	:	1902962228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD KERSHAW LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1108
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76503-1108
Country	:	US
Telephone Number	:	254-773-4022
Fax Number	:	254-773-0919

Provider Business Practice Location Address
First Line	:	3010 SCOTT BLVD STE 103
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6803
Country	:	US
Telephone Number	:	254-773-4022
Fax Number	:	254-773-0919

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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