MEDICARE: MS. VERONICA LIGGINS MAC

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	:	1235325150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERONICA LIGGINS MAC

Provider Business Mailing Address
First Line	:	1348 GREENTREE VLY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5817
Country	:	US
Telephone Number	:	901-252-7899
Fax Number	:	901-252-7880

Provider Business Practice Location Address
First Line	:	7410 MEMPHIS ARLINGTON ROAD
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38002
Country	:	US
Telephone Number	:	901-252-7899
Fax Number	:	901-252-7880

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

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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