MEDICARE: MRS. BETH ANN CALHOUN 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	101YP2500X	Professional Counselor	18434	TX

General Provider Information

NPI Number	:	1417067570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH ANN CALHOUN LPC

Provider Business Mailing Address
First Line	:	3240 RIVER LODGE TRL S APT 328
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76116-0826
Country	:	US
Telephone Number	:	817-243-8195
Fax Number	:

Provider Business Practice Location Address
First Line	:	7833 OAKMONT BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76132-4231
Country	:	US
Telephone Number	:	817-243-8195
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	02/23/2015

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