MEDICARE: TIPHYNEE ANNE SALAZAR M.S., LPC

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	70084	TX

General Provider Information

NPI Number	:	1306227251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIPHYNEE ANNE SALAZAR M.S., LPC

Provider Business Mailing Address
First Line	:	305 REGENCY PKWY
Second Line	:	STE. 601
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3794
Country	:	US
Telephone Number	:	682-518-3337
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 REGENCY PKWY
Second Line	:	STE. 601
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3794
Country	:	US
Telephone Number	:	682-518-3337
Fax Number	:

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

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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