MEDICARE: FM COACHING & COUNSELING 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	1041C0700X	Clinical Social Worker	32691	TX

General Provider Information

NPI Number	:	1740427384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FM COACHING & COUNSELING LLC

Provider Business Mailing Address
First Line	:	7221 CANYON RUN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-7213
Country	:	US
Telephone Number	:	915-491-5709
Fax Number	:	915-585-9990

Provider Business Practice Location Address
First Line	:	5758 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5427
Country	:	US
Telephone Number	:	915-585-9990
Fax Number	:	915-585-9990

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KIMBERLY H BRENNER
Credential	:	LCSW
Telephone Number	:	915-491-5709

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	01/28/2009

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