| Theresa Fusaro, LPC | |
|
712 S May St, Madisonville, TX 77864-2564 | |
| (936) 348-3418 | |
| (936) 349-0656 |
| Full Name | Theresa Fusaro |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 712 S May St, Madisonville, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689335895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 13014 (Texas) | Primary |
| Entity Name | Brazos Valley Community Action Agency Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649265646 PECOS PAC ID: 4284542127 Enrollment ID: O20040708001095 |
| Mailing Address | Practice Location Address |
|---|---|
| Theresa Fusaro, LPC 1500 University Dr E Ste 100, College Station, TX 77840-2600 Ph: (979) 383-2340 | Theresa Fusaro, LPC 712 S May St, Madisonville, TX 77864-2564 Ph: (936) 348-3418 |
Michael Freeman Lee, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 404 N. May, Suite- C, Madisonville, TX 77864 Phone: 936-348-9282 | |
Laquita Clewis, LCDC Counselor Medicare: Not Enrolled in Medicare Practice Location: 207 N Panama St, Madisonville, TX 77864 Phone: 936-349-0589 Fax: 866-562-2811 | |
Ms. Kelly Elizabeth Morgan, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 813 South State Street, Ste. 100, Madisonville, TX 77864 Phone: 936-348-3516 Fax: 936-348-3163 |