MEDICARE: ANN MARY WILLIAMS OUTLAW

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
2	1041C0700X	Clinical Social Worker	108372	TX

General Provider Information

NPI Number	:	1407565658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARY WILLIAMS OUTLAW

Provider Business Mailing Address
First Line	:	734 LONG MDW
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-5956
Country	:	US
Telephone Number	:	512-592-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	734 LONG MDW
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-5956
Country	:	US
Telephone Number	:	512-592-9310
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	08/30/2024

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