MEDICARE: JERILYNN LANDGRAF 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	71553	TX

General Provider Information

NPI Number	:	1467818898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERILYNN LANDGRAF LPC

Provider Business Mailing Address
First Line	:	1005 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4509
Country	:	US
Telephone Number	:	817-271-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4509
Country	:	US
Telephone Number	:	817-271-2818
Fax Number	:

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

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	01/14/2016

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Directions to “ JERILYNN LANDGRAF LPC” Practice Location

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