MEDICARE: WILLIE JAMES ATKINS MA COUNSELING

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	101Y00000X	Counselor	62490	TX

General Provider Information

NPI Number	:	1518191774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIE JAMES ATKINS MA COUNSELING

Provider Business Mailing Address
First Line	:	3306 BALOMEDE ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75216-2429
Country	:	US
Telephone Number	:	972-228-4267
Fax Number	:	972-228-4267

Provider Business Practice Location Address
First Line	:	2202 HARLANDALE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-2429
Country	:	US
Telephone Number	:	972-375-4766
Fax Number	:	972-228-4267

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

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	05/04/2009

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