MEDICARE: JEFFREY MINCHEW 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	16849	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6168LC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1437296647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MINCHEW LPC

Provider Business Mailing Address
First Line	:	311 S. CENTRAL AVE.
Second Line	:
City	:	HALLSVILLE
State	:	TX
Zip	:	75650
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 S. CENTRAL AVE.
Second Line	:
City	:	HALLSVILLE
State	:	TX
Zip	:	75650
Country	:	US
Telephone Number	:	903-235-5862
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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