MEDICARE: AWEN PSYCHOLOGICAL SERVICES, PLLC

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	103TC0700X	Clinical Psychologist	37280	TX

General Provider Information

NPI Number	:	1568969590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWEN PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	3650 CEDARPLAZA LN APT 1128
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-6326
Country	:	US
Telephone Number	:	281-793-6072
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 CEDARPLAZA LN APT 1128
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-6326
Country	:	US
Telephone Number	:	281-793-6072
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. THERRON PATRICK HUME
Credential	:	PSY.D
Telephone Number	:	281-793-6072

Provider Enumeration Date	:	04/06/2018
Last Update Date	:	04/06/2018

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