MEDICARE: MRS. PEGGY JEANNE NIX LPC REGISTERED PLAY

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	13653	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	83400L	OTHER	BLUE CROSS BLUE SHIELD
2	338029	OTHER	VALUE OPTIONS
3	2603939	OTHER	AETNA

General Provider Information

NPI Number	:	1396810115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEGGY JEANNE NIX LPC REGISTERED PLAY

Provider Business Mailing Address
First Line	:	4037 PARCHMAN
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8801
Country	:	US
Telephone Number	:	817-595-2520
Fax Number	:	817-284-8742

Provider Business Practice Location Address
First Line	:	4037 PARCHMAN
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8801
Country	:	US
Telephone Number	:	817-595-2520
Fax Number	:	817-284-8742

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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