MEDICARE: LORIE ANN MOBLEY AMMON LPC

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	69984	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	69984	OTHER	TX	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1780082370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE ANN MOBLEY AMMON LPC

Provider Business Mailing Address
First Line	:	7557 RAMBLER RD STE 730
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2405
Country	:	US
Telephone Number	:	972-638-0905
Fax Number	:	214-696-2977

Provider Business Practice Location Address
First Line	:	7557 RAMBLER RD STE 730
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2405
Country	:	US
Telephone Number	:	972-638-0905
Fax Number	:	214-696-2977

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

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	12/11/2019

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