MEDICARE: LAURA MELLON L.AC.

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1346718574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MELLON L.AC.

Provider Business Mailing Address
First Line	:	3917 BOOTH CALLOWAY RD
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-5325
Country	:	US
Telephone Number	:	817-284-8124
Fax Number	:	844-210-8191

Provider Business Practice Location Address
First Line	:	3917 BOOTH CALLOWAY RD
Second Line	:
City	:	RICHLAND HILLS
State	:	TX
Zip	:	76118-5325
Country	:	US
Telephone Number	:	817-284-8124
Fax Number	:

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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Directions to “ LAURA MELLON L.AC.” Practice Location

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