MEDICARE: BILLY DALE MOSTELLER

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	66344	TX

General Provider Information

NPI Number	:	1255763215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY DALE MOSTELLER

Provider Business Mailing Address
First Line	:	1703 S AVONDALE ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4516
Country	:	US
Telephone Number	:	806-353-2822
Fax Number	:	806-353-2835

Provider Business Practice Location Address
First Line	:	1703 S AVONDALE ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4516
Country	:	US
Telephone Number	:	806-353-2822
Fax Number	:	806-353-2835

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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