MEDICARE: VIRGINIA F. MAHAN LCSW

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	1041C0700X	Clinical Social Worker	4207	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00S78Y	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1689754863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA F. MAHAN LCSW

Provider Business Mailing Address
First Line	:	1801 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	832-620-6583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 LEXINGTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4303
Country	:	US
Telephone Number	:	832-620-6583
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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