MEDICARE: DR. DONNA MONCRIEF 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	17268	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10016284	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1740332188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA MONCRIEF LPC

Provider Business Mailing Address
First Line	:	7213 RED HAWK CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4106
Country	:	US
Telephone Number	:	817-263-6200
Fax Number	:	817-263-6202

Provider Business Practice Location Address
First Line	:	7213 RED HAWK CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4106
Country	:	US
Telephone Number	:	817-263-6200
Fax Number	:	817-263-6202

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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