MEDICARE: MRS. NATALIE DORINE WINGARD MS

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	81188	TX

General Provider Information

NPI Number	:	1720664170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATALIE DORINE WINGARD MS

Provider Business Mailing Address
First Line	:	3939 W GREEN OAKS BLVD STE 214
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2793
Country	:	US
Telephone Number	:	469-490-1442
Fax Number	:	214-380-4965

Provider Business Practice Location Address
First Line	:	3939 W GREEN OAKS BLVD STE 214
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-2793
Country	:	US
Telephone Number	:	469-490-1442
Fax Number	:	214-380-4965

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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