MEDICARE: RECOVERY IS POSSIBLE

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
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932514155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY IS POSSIBLE

Provider Business Mailing Address
First Line	:	3146 BONNEY BRIAR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3113
Country	:	US
Telephone Number	:	832-421-0548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3146 BONNEY BRIAR DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3113
Country	:	US
Telephone Number	:	832-421-0548
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONNA JO KOCUREK
Credential	:
Telephone Number	:	281-750-1862

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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