MEDICARE: MARY TORKELSON

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	83467	TX

General Provider Information

NPI Number	:	1316578479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TORKELSON

Provider Business Mailing Address
First Line	:	207 WESTHAVEN DR
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-4442
Country	:	US
Telephone Number	:	512-762-2331
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 BEE CAVES RD STE A2
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5248
Country	:	US
Telephone Number	:	512-762-2331
Fax Number	:

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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