MEDICARE: AHILLAN SIVAKUMARAN 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	101Y00000X	Counselor	73197	TX

General Provider Information

NPI Number	:	1083224158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHILLAN SIVAKUMARAN LPC

Provider Business Mailing Address
First Line	:	1032 MADELIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-1072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7535 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4236
Country	:	US
Telephone Number	:	800-972-0643
Fax Number	:	214-279-5032

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

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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Directions to “ AHILLAN SIVAKUMARAN LPC” Practice Location

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