MEDICARE: MR. DARRELL ARLINE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1184950230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARRELL ARLINE

Provider Business Mailing Address
First Line	:	9111 LAKES AT 610 DR APT 228
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2407
Country	:	US
Telephone Number	:	713-456-0686
Fax Number	:

Provider Business Practice Location Address
First Line	:	9111 LAKES AT 610 DR APT 228
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2407
Country	:	US
Telephone Number	:	713-456-0686
Fax Number	:

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

Provider Enumeration Date	:	10/26/2009
Last Update Date	:	10/26/2009

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