MEDICARE: HEATHER BOBO, LPC, PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1114318177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER BOBO, LPC, PLLC

Provider Business Mailing Address
First Line	:	2220 SAN JACINTO BLVD
Second Line	:	SUITE 320
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-390-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 SAN JACINTO BLVD
Second Line	:	SUITE 320
City	:	DENTON
State	:	TX
Zip	:	76205-7589
Country	:	US
Telephone Number	:	940-390-5134
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HEATHER BOBO
Credential	:	LPC
Telephone Number	:	940-390-5134

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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