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NPI Code Detail

MEDICARE: MR. MICHAEL SHANE MONROE LCSW

MEDICARE: MR. MICHAEL SHANE MONROE LCSW
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
11041C0700XClinical Social Worker54398TX

General Provider Information

NPI Number : 1376051052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL SHANE MONROE LCSW
Provider Business Mailing Address
First Line : 8532 PEDERNALES TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76118-7486
Country : US
Telephone Number : 469-452-9168
Fax Number :
Provider Business Practice Location Address
First Line : 612 E LAMAR BLVD
Second Line :
City : ARLINGTON
State : TX
Zip : 76011-4121
Country : US
Telephone Number : 469-452-9168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2018
Last Update Date : 03/17/2018

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