MEDICARE: CAROL HOLIDAY BEAN

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	103T00000X	Psychologist	37244	TX
2	103TC0700X	Clinical Psychologist	37244	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518392075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL HOLIDAY BEAN

Provider Business Mailing Address
First Line	:	7801 OAKMONT BLVD STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4242
Country	:	US
Telephone Number	:	682-841-1475
Fax Number	:	682-708-3775

Provider Business Practice Location Address
First Line	:	7801 OAKMONT BLVD STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4242
Country	:	US
Telephone Number	:	682-841-1475
Fax Number	:	682-708-3775

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	10/11/2023

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Directions to “ CAROL HOLIDAY BEAN ” Practice Location

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