MEDICARE: KAREN MEAD WILBUR PHD

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	103TC0700X	Clinical Psychologist	34254	TX

General Provider Information

NPI Number	:	1134185366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MEAD WILBUR PHD

Provider Business Mailing Address
First Line	:	4100 SPRING VALLEY RD
Second Line	:	SUITE 511
City	:	DALLAS
State	:	TX
Zip	:	75244-3629
Country	:	US
Telephone Number	:	972-934-1485
Fax Number	:	972-934-1498

Provider Business Practice Location Address
First Line	:	4100 SPRING VALLEY RD
Second Line	:	SUITE 511
City	:	DALLAS
State	:	TX
Zip	:	75244-3629
Country	:	US
Telephone Number	:	972-934-1485
Fax Number	:	972-934-1498

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	09/29/2009

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