MEDICARE: MARY ELIZABETH KENT LPC

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	LPC 1165	AZ
2	101YP2500X	Professional Counselor	LPC 1165	AZ

General Provider Information

NPI Number	:	1962786343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH KENT LPC

Provider Business Mailing Address
First Line	:	1080 S 10TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-2907
Country	:	US
Telephone Number	:	520-202-1870
Fax Number	:	520-594-6345

Provider Business Practice Location Address
First Line	:	1080 S 10TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-2907
Country	:	US
Telephone Number	:	520-202-1870
Fax Number	:	520-594-6345

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

Provider Enumeration Date	:	10/04/2011
Last Update Date	:	10/04/2011

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