MEDICARE: LOVING YOURSELF WELL COUNSELING AGENCY

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	251S00000X	Community/Behavioral Health Agency	73002	TX

General Provider Information

NPI Number	:	1417483686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOVING YOURSELF WELL COUNSELING AGENCY

Provider Business Mailing Address
First Line	:	828 TIMBER DELL
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232
Country	:	US
Telephone Number	:	469-744-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	1633 EXETER AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-6305
Country	:	US
Telephone Number	:	469-744-2693
Fax Number	:

Authorized Official
Title or Position	:	LICENSE PROFESSIONAL COUNSELOR
Name	:	MS. KIMBERLY PEARSON
Credential	:	LPC
Telephone Number	:	469-744-2693

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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