MEDICARE: CAREY MICHAEL FERREN LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1760089395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAREY MICHAEL FERREN LCDC

Provider Business Mailing Address
First Line	:	4036 FLINTRIDGE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-6616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5344 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3428
Country	:	US
Telephone Number	:	817-996-7616
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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