MEDICARE: MS. TABATHA FURLOUGH

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1588819387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TABATHA FURLOUGH

Provider Business Mailing Address
First Line	:	2551 ALAMAIN DRIVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	628 CENTRE ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6328
Country	:	US
Telephone Number	:	214-941-0798
Fax Number	:

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

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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Directions to “ MS. TABATHA FURLOUGH ” Practice Location

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