MEDICARE: MARY FOGEL

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	6273	TX

General Provider Information

NPI Number	:	1770236176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY FOGEL

Provider Business Mailing Address
First Line	:	2612 PIPING ROCK TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5945
Country	:	US
Telephone Number	:	512-554-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 PIPING ROCK TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5945
Country	:	US
Telephone Number	:	512-554-8150
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2022

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