Active NPI
Cory Puckett, LPC INTERN
- Counselor
- Dallas, TX
National Provider Identifier
1225319148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 67500
- Practice address
- 17103 Preston Rd
Ste 250
Dallas, TX 75248-1332 - Phone
- (972) 250-1700
- Fax
- (972) 250-1701
- NPI assigned
- Sep 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 67500 | TX | Primary |
Addresses
Primary practice location
17103 Preston Rd
Ste 250
Dallas, TX 75248-1332
Mailing address
17103 Preston Rd
Ste 250
Dallas, TX 75248-1332
Phone (972) 250-1700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67500 | TX | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1225319148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17103 PRESTON RD",
"address_2": "STE 250",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481332",
"telephone_number": "972-250-1700",
"fax_number": "972-250-1701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17103 PRESTON RD",
"address_2": "STE 250",
"city": "DALLAS",
"state": "TX",
"postal_code": "752481332",
"telephone_number": "972-250-1700",
"fax_number": "972-250-1701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUCKETT",
"first_name": "CORY",
"credential": "LPC INTERN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-06",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "TX",
"license": "67500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.