MEDICARE: PEGGY E HALYARD M.S., L.P.C.

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	101YP2500X	Professional Counselor	14706	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3675LC	OTHER	TX	BCBS/TX

General Provider Information

NPI Number	:	1578644134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY E HALYARD M.S., L.P.C.

Provider Business Mailing Address
First Line	:	2525 NORTH LOOP W STE 220
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1082
Country	:	US
Telephone Number	:	713-426-1669
Fax Number	:	713-868-9416

Provider Business Practice Location Address
First Line	:	560 BLOSSOM ST STE B
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-4237
Country	:	US
Telephone Number	:	281-338-1382
Fax Number	:	281-488-3841

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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