MEDICARE: EMILY MABERRY

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	18229	TX

General Provider Information

NPI Number	:	1679897789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MABERRY

Provider Business Mailing Address
First Line	:	930 W COLORADO BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2632
Country	:	US
Telephone Number	:	214-415-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 W COLORADO BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-2632
Country	:	US
Telephone Number	:	214-415-8025
Fax Number	:

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

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	03/18/2010

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Directions to “ EMILY MABERRY ” Practice Location

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