MEDICARE: MS. MARY LYNNE MACGREGOR PHD

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	106H00000X	Marriage & Family Therapist	3386	TX

General Provider Information

NPI Number	:	1073617221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY LYNNE MACGREGOR PHD

Provider Business Mailing Address
First Line	:	3609 CEDAR SPRINGS
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4905
Country	:	US
Telephone Number	:	214-521-4810
Fax Number	:	214-521-7334

Provider Business Practice Location Address
First Line	:	3609 CEDAR SPRINGS
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4905
Country	:	US
Telephone Number	:	214-521-4810
Fax Number	:	214-521-7334

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	07/08/2007

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