MEDICARE: YVONNE CHAMPION LCSW

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	23264	TX

General Provider Information

NPI Number	:	1083820849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE CHAMPION LCSW

Provider Business Mailing Address
First Line	:	11200 WESTHEIMER RD
Second Line	:	SUITE 900
City	:	HOUSTON
State	:	TX
Zip	:	77042-3227
Country	:	US
Telephone Number	:	832-654-5168
Fax Number	:	713-243-8801

Provider Business Practice Location Address
First Line	:	11200 WESTHEIMER RD
Second Line	:	SUITE 900
City	:	HOUSTON
State	:	TX
Zip	:	77042-3227
Country	:	US
Telephone Number	:	832-654-5168
Fax Number	:	713-243-8801

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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