MEDICARE: CAROL SPECKMAN LPC

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	12799	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6650LC	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1427145853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL SPECKMAN LPC

Provider Business Mailing Address
First Line	:	PO BOX 940165
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75094-0165
Country	:	US
Telephone Number	:	972-424-9212
Fax Number	:	972-509-1450

Provider Business Practice Location Address
First Line	:	100 N CENTRAL EXPY
Second Line	:	SUITE 402
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5332
Country	:	US
Telephone Number	:	972-786-6464
Fax Number	:	214-238-1221

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	04/06/2009

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Directions to “ CAROL SPECKMAN LPC” Practice Location

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