MEDICARE: CLAIBORN HAILEY LPC

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	59911	TX

General Provider Information

NPI Number	:	1689998999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIBORN HAILEY LPC

Provider Business Mailing Address
First Line	:	1448 WIND DANCER TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5415
Country	:	US
Telephone Number	:	972-571-2712
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 WIND DANCER TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-5415
Country	:	US
Telephone Number	:	972-571-2712
Fax Number	:

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

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/16/2010

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Directions to “ CLAIBORN HAILEY LPC” Practice Location

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