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NPI Code Detail

MEDICARE: AVERY WASSON LPC-A

MEDICARE: AVERY WASSON LPC-A
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 Counselor91778TX

General Provider Information

NPI Number : 1942084041
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY WASSON LPC-A
Provider Business Mailing Address
First Line : 4305 MACARTHUR AVE
Second Line :
City : DALLAS
State : TX
Zip : 75209-6511
Country : US
Telephone Number : 214-526-4525
Fax Number : 214-520-6468
Provider Business Practice Location Address
First Line : 4305 MACARTHUR AVE
Second Line :
City : DALLAS
State : TX
Zip : 75209-6511
Country : US
Telephone Number : 214-526-4525
Fax Number : 214-520-6468
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 12/12/2025

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Directions to “ AVERY WASSON LPC-A” Practice Location

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