Active NPI
Theresa Fusaro, LPC
- Professional Counselor
- Madisonville, TX
National Provider Identifier
1689335895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 13014
- Practice address
- 712 S May St
Madisonville, TX 77864-2564 - Phone
- (936) 348-3418
- Fax
- (936) 349-0656
- NPI assigned
- Jan 10, 2022
- Last updated
- Sep 12, 2024
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 13014 | TX | Primary |
Addresses
Primary practice location
712 S May St
Madisonville, TX 77864-2564
Mailing address
1500 University Dr E Ste 100
College Station, TX 77840-2600
Phone (979) 383-2340
Other practice location 1
315 Prospect Dr
Trinity, TX 75862-6202
Phone (936) 744-1400
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13014 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1641772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726099200000",
"number": "1689335895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 UNIVERSITY DR E STE 100",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778402600",
"telephone_number": "979-383-2340",
"fax_number": "979-260-9390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 S MAY ST",
"city": "MADISONVILLE",
"state": "TX",
"postal_code": "778642564",
"telephone_number": "936-348-3418",
"fax_number": "936-349-0656"
}
],
"practiceLocations": [
{
"address_1": "315 Prospect Dr",
"address_purpose": "LOCATION",
"city": "Trinity",
"state": "TX",
"postal_code": "758626202",
"country_code": "US",
"telephone_number": "936-744-1400",
"fax_number": "936-594-2418",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "FUSARO",
"first_name": "THERESA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-01-10",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "13014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madisonville, TX
- Darren Glenn Dye
- Charlotte Gaye Ellis, APRN-BC
- Mallison Fisher, MS,CCC-SLP
- Franklin Healthcare of Madisonville, LLC (Riverwood Healthcare & Rehab)
- Joe W Franklin, M.D.
- Kelle Dawn Harper, NP
- HCC-Healthcare Properties, LLC (Riverwood Healthcare & Rehabilitation)
- Cynthia Raye Horne, RN
- Jared Adam Hough, PA-C
- Grover Cleveland Hubley Jr., MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.