MEDICARE: MANDY RENE' SCOTT WESTERMAN LMSW

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

General Provider Information

NPI Number	:	1023156346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDY RENE' SCOTT WESTERMAN LMSW

Provider Business Mailing Address
First Line	:	2231 WELLSPRING LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-0927
Country	:	US
Telephone Number	:	731-414-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 UNION AVENUE EXT STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4436
Country	:	US
Telephone Number	:	901-320-6112
Fax Number	:

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	01/25/2010

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