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NPI Code Detail

MEDICARE: EMILY RUNNELS

MEDICARE: EMILY RUNNELS
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
1101YM0800XMental Health Counselor88408TX

General Provider Information

NPI Number : 1578207080
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY RUNNELS
Provider Business Mailing Address
First Line : PO BOX 190867
Second Line :
City : DALLAS
State : TX
Zip : 75219-0867
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3500 OAK LAWN AVE STE 730
Second Line :
City : DALLAS
State : TX
Zip : 75219-6721
Country : US
Telephone Number : 214-717-9981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2022
Last Update Date : 04/21/2022

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Directions to “ EMILY RUNNELS ” Practice Location

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