MEDICARE: SONG E PAIK LMFT

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	204161	TX
2	106H00000X	Marriage & Family Therapist	35002077A	IN
3	106H00000X	Marriage & Family Therapist	85000332A	IN

General Provider Information

NPI Number	:	1083187496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONG E PAIK LMFT

Provider Business Mailing Address
First Line	:	8304 TAVAROS DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7230
Country	:	US
Telephone Number	:	972-246-8198
Fax Number	:

Provider Business Practice Location Address
First Line	:	8304 TAVAROS DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7230
Country	:	US
Telephone Number	:	972-246-8198
Fax Number	:

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

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	01/05/2026

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Directions to “ SONG E PAIK LMFT” Practice Location

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