MEDICARE: MRS. SALLIE S. MEINEN LPC

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	20072	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215042148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SALLIE S. MEINEN LPC

Provider Business Mailing Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 1002
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-204-0162
Fax Number	:	817-336-1740

Provider Business Practice Location Address
First Line	:	1701 RIVER RUN
Second Line	:	SUITE 1002
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6579
Country	:	US
Telephone Number	:	817-204-0162
Fax Number	:	817-336-1740

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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