MEDICARE: DR. THERRON HUME PSY.D.

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

General Provider Information

NPI Number	:	1174946925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERRON HUME PSY.D.

Provider Business Mailing Address
First Line	:	2668 THROCKMORTON ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6612 N RIVERSIDE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6663
Country	:	US
Telephone Number	:	817-232-8877
Fax Number	:

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

Provider Enumeration Date	:	01/30/2014
Last Update Date	:	01/30/2014

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