MEDICARE: MARK SPURLOCK LMFT

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	106H00000X	Marriage & Family Therapist	239	AL

General Provider Information

NPI Number	:	1528402906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SPURLOCK LMFT

Provider Business Mailing Address
First Line	:	3232 LAY SPRINGS RD
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35904-8611
Country	:	US
Telephone Number	:	256-546-6324
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 LAY SPRINGS RD
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35904-8611
Country	:	US
Telephone Number	:	256-546-6324
Fax Number	:

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	04/29/2013

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