MEDICARE: MRS. JIMMIE LYNN EKOLA LMSW

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	104100000X	Social Worker	52473	TX
2	101Y00000X	Counselor	52473	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	12058	TX

General Provider Information

NPI Number	:	1750516902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIMMIE LYNN EKOLA LMSW

Provider Business Mailing Address
First Line	:	10324 BALLYMOTE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-4344
Country	:	US
Telephone Number	:	915-595-4320
Fax Number	:

Provider Business Practice Location Address
First Line	:	10324 BALLYMOTE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-4344
Country	:	US
Telephone Number	:	915-861-6287
Fax Number	:

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

Provider Enumeration Date	:	05/18/2009
Last Update Date	:	06/17/2014

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