MEDICARE: MR. RONNY PIPES MA, LPC-S

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	101YP2500X	Professional Counselor	012726	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104997352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONNY PIPES MA, LPC-S

Provider Business Mailing Address
First Line	:	13896 MAXWELL BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-9228
Country	:	US
Telephone Number	:	817-689-7887
Fax Number	:	214-648-0167

Provider Business Practice Location Address
First Line	:	4913 RUFE SNOW DR
Second Line	:	SUITE 101-C
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7856
Country	:	US
Telephone Number	:	817-689-7887
Fax Number	:	214-648-0167

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

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/09/2012

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