MEDICARE: ANDREA MUTSCHLER

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	LF60895090	WA
2	106H00000X	Marriage & Family Therapist	204609	TX

General Provider Information

NPI Number	:	1114472933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MUTSCHLER

Provider Business Mailing Address
First Line	:	6060 AZLE AVE STE 700-117
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2607
Country	:	US
Telephone Number	:	817-859-8995
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 AZLE AVE STE 700-117
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2607
Country	:	US
Telephone Number	:	817-859-8995
Fax Number	:

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

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	08/15/2022

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Directions to “ ANDREA MUTSCHLER ” Practice Location

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