MEDICARE: MARY HONEA MCCLUNG

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	106H00000X	Marriage & Family Therapist	4633	TX

General Provider Information

NPI Number	:	1457402414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY HONEA MCCLUNG

Provider Business Mailing Address
First Line	:	2015 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5411
Country	:	US
Telephone Number	:	210-823-1772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5411
Country	:	US
Telephone Number	:	210-823-1772
Fax Number	:

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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