MEDICARE: MRS. STACY ANN LYNCH RODRIGUEZ 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	171M00000X	Case Manager/Care Coordinator	50551	TX

General Provider Information

NPI Number	:	1003196841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY ANN LYNCH RODRIGUEZ LMSW

Provider Business Mailing Address
First Line	:	P.O. BOX 351
Second Line	:
City	:	EVANT
State	:	TX
Zip	:	76525
Country	:	US
Telephone Number	:	254-716-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	758 COUNTY ROAD 417
Second Line	:
City	:	EVANT
State	:	TX
Zip	:	76525
Country	:	US
Telephone Number	:	254-716-2035
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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