MEDICARE: MS. MARCIA B. DUBOIS 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	101YM0800X	Mental Health Counselor	S09673	TX

General Provider Information

NPI Number	:	1740278894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA B. DUBOIS LCSW

Provider Business Mailing Address
First Line	:	1007 W MITCHELL ST
Second Line	:	SUITE 102
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2508
Country	:	US
Telephone Number	:	817-461-6183
Fax Number	:	817-265-7433

Provider Business Practice Location Address
First Line	:	1007 W MITCHELL ST
Second Line	:	SUITE 102
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2508
Country	:	US
Telephone Number	:	817-461-6183
Fax Number	:	817-265-7433

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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