MEDICARE: MS. KERRI LYNN DEE LCSW, QMHP

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1932254208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRI LYNN DEE LCSW, QMHP

Provider Business Mailing Address
First Line	:	1917 MADISON AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2222
Country	:	US
Telephone Number	:	512-767-5825
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 MADISON AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-2222
Country	:	US
Telephone Number	:	512-767-5825
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	03/10/2008

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