MEDICARE: MRS. SHANDRA DAWN MAPLES-EAKES 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	32840	TX

General Provider Information

NPI Number	:	1710127428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANDRA DAWN MAPLES-EAKES LCSW

Provider Business Mailing Address
First Line	:	1000 HOLLOW CREEK RD
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-0608
Country	:	US
Telephone Number	:	817-995-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HOLLOW CREEK RD
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-0608
Country	:	US
Telephone Number	:	817-995-8691
Fax Number	:

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

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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