MEDICARE: MEAGHAN DANIELLE SEMPLE 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	66742	TX

General Provider Information

NPI Number	:	1952738767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEAGHAN DANIELLE SEMPLE LPC

Provider Business Mailing Address
First Line	:	1603 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4552
Country	:	US
Telephone Number	:	817-657-8616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 WASHINGTON AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4552
Country	:	US
Telephone Number	:	817-657-8616
Fax Number	:

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

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	01/12/2022

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