MEDICARE: DR. MARY G YANCY 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	103T00000X	Psychologist	33382	TX

General Provider Information

NPI Number	:	1174757538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY G YANCY PHD

Provider Business Mailing Address
First Line	:	100 SKYLINE DR
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-3609
Country	:	US
Telephone Number	:	512-328-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 STECK AVE STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-7584
Country	:	US
Telephone Number	:	512-452-2929
Fax Number	:

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

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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