MEDICARE: WIB NEWTON, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	14311	TX

General Provider Information

NPI Number	:	1144629569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIB NEWTON, PLLC

Provider Business Mailing Address
First Line	:	4211 W I 40
Second Line	:	SUITE 203
City	:	AMARILLO
State	:	TX
Zip	:	79106-6053
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

Provider Business Practice Location Address
First Line	:	4211 W I 40
Second Line	:	SUITE 203
City	:	AMARILLO
State	:	TX
Zip	:	79106-6053
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. WILBERT J NEWTON
Credential	:	LPC-S, LMFT
Telephone Number	:	806-374-5950

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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