MEDICARE: CHANCE WAYNE HENDRIX

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	1041C0700X	Clinical Social Worker	56368	TX

General Provider Information

NPI Number	:	1073962379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANCE WAYNE HENDRIX

Provider Business Mailing Address
First Line	:	10309 NEWCOMBE DR.
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228
Country	:	US
Telephone Number	:	214-600-9557
Fax Number	:

Provider Business Practice Location Address
First Line	:	10309 NEWCOMBE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3238
Country	:	US
Telephone Number	:	214-600-9557
Fax Number	:

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	06/07/2016

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Directions to “ CHANCE WAYNE HENDRIX ” Practice Location

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