MEDICARE: SPEAKLIFE2020 LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1740016856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAKLIFE2020 LLC

Provider Business Mailing Address
First Line	:	2245 KELLER WAY STE 150D
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 KELLER WAY STE 150D
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2515
Country	:	US
Telephone Number	:	469-892-8440
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	TAMMY VARGHESE
Credential	:	LPC
Telephone Number	:	214-498-3390

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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Directions to “SPEAKLIFE2020 LLC ” Practice Location

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