MEDICARE: MAXINE WESTMORELAND LCDC, LPCI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12356	TX

General Provider Information

NPI Number	:	1437577608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE WESTMORELAND LCDC, LPCI

Provider Business Mailing Address
First Line	:	PO BOX 20620
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79114-2620
Country	:	US
Telephone Number	:	806-433-0257
Fax Number	:	806-354-0011

Provider Business Practice Location Address
First Line	:	2901 SE 11TH AVE
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79104-2515
Country	:	US
Telephone Number	:	806-433-0257
Fax Number	:	806-354-0011

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

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	04/03/2014

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