MEDICARE: HENRIETTA PRICE MA, 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	101YM0800X	Mental Health Counselor	60320	TX

General Provider Information

NPI Number	:	1477803260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRIETTA PRICE MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 226296
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-6296
Country	:	US
Telephone Number	:	214-850-6823
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 MCCART AVE STE 302
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4230
Country	:	US
Telephone Number	:	214-850-6823
Fax Number	:

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

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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