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NPI Code Detail

MEDICARE: SAMUEL AUSTIN SPILLYARDS LMSW

MEDICARE: SAMUEL AUSTIN SPILLYARDS LMSW
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
1104100000XSocial Worker108949TX

General Provider Information

NPI Number : 1447941240
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL AUSTIN SPILLYARDS LMSW
Provider Business Mailing Address
First Line : 2817 OAK FOREST DR
Second Line :
City : GRAPEVINE
State : TX
Zip : 76051-6018
Country : US
Telephone Number : 817-789-0444
Fax Number :
Provider Business Practice Location Address
First Line : 1771 INTERNATIONAL PKWY STE 107
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-1865
Country : US
Telephone Number : 972-696-9359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2023
Last Update Date : 05/15/2023

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