MEDICARE: MRS. PEGGY A UNRUH LCSW

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	1041C0700X	Clinical Social Worker	33472	TX

General Provider Information

NPI Number	:	1326193145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PEGGY A UNRUH LCSW

Provider Business Mailing Address
First Line	:	17171 PARK ROW
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77084-4927
Country	:	US
Telephone Number	:	281-398-2509
Fax Number	:	281-398-2688

Provider Business Practice Location Address
First Line	:	17171 PARK ROW
Second Line	:	SUITE 150
City	:	HOUSTON
State	:	TX
Zip	:	77084-4927
Country	:	US
Telephone Number	:	281-398-2509
Fax Number	:	281-398-2688

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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