MEDICARE: MS. HELEN R STAGG LMSW

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	171M00000X	Case Manager/Care Coordinator	55573	TX

General Provider Information

NPI Number	:	1245517077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN R STAGG LMSW

Provider Business Mailing Address
First Line	:	3353 ELGIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-3531
Country	:	US
Telephone Number	:	713-374-1285
Fax Number	:	713-651-8045

Provider Business Practice Location Address
First Line	:	3353 ELGIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-3531
Country	:	US
Telephone Number	:	713-374-1285
Fax Number	:	713-651-8045

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

Provider Enumeration Date	:	11/08/2011
Last Update Date	:	11/08/2011

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