MEDICARE: MS. KAREN ELIZABETH MUDD 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
1	1041C0700X	Clinical Social Worker	54075	TX

General Provider Information

NPI Number	:	1508162421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN ELIZABETH MUDD LMSW

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	713-830-3087
Fax Number	:	713-523-4897

Provider Business Practice Location Address
First Line	:	215 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-3221
Country	:	US
Telephone Number	:	713-830-3000
Fax Number	:	713-523-4897

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

Provider Enumeration Date	:	02/10/2011
Last Update Date	:	02/10/2011

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