MEDICARE: ANNIE MELISSA MAUNEY LBSW, LCDC

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	171M00000X	Case Manager/Care Coordinator	34399	TX

General Provider Information

NPI Number	:	1144393901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MELISSA MAUNEY LBSW, LCDC

Provider Business Mailing Address
First Line	:	752 COUNTY ROAD 417
Second Line	:
City	:	EVANT
State	:	TX
Zip	:	76525-2532
Country	:	US
Telephone Number	:	254-471-5906
Fax Number	:	866-560-7260

Provider Business Practice Location Address
First Line	:	752 COUNTY ROAD 417
Second Line	:
City	:	EVANT
State	:	TX
Zip	:	76525-2532
Country	:	US
Telephone Number	:	254-471-5906
Fax Number	:	866-560-7260

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/09/2007

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