MEDICARE: WENDY M EZELL

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	66405	TX

General Provider Information

NPI Number	:	1700122496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDY M EZELL

Provider Business Mailing Address
First Line	:	5210 MCKINNEY AVE # 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3357
Country	:	US
Telephone Number	:	214-498-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 MCKINNEY AVE # 225
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-3357
Country	:	US
Telephone Number	:	214-498-1513
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	WENDY EZELL
Credential	:	LPC
Telephone Number	:	214-498-1513

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	12/27/2012

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