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NPI Code Detail

MEDICARE: JAMES MADISON WEST MS

MEDICARE: JAMES MADISON WEST MS
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
1101YM0800XMental Health Counselor79624TX

General Provider Information

NPI Number : 1386127082
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MADISON WEST MS
Provider Business Mailing Address
First Line : 3300 OAK LAWN AVE STE 601
Second Line :
City : DALLAS
State : TX
Zip : 75219-4439
Country : US
Telephone Number : 214-310-0417
Fax Number :
Provider Business Practice Location Address
First Line : 3300 OAK LAWN AVE STE 601
Second Line :
City : DALLAS
State : TX
Zip : 75219-4439
Country : US
Telephone Number : 214-310-0417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2018
Last Update Date : 09/10/2018

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