MEDICARE: A SAFE PLACE TO HEAL

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

General Provider Information

NPI Number	:	1760621767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A SAFE PLACE TO HEAL

Provider Business Mailing Address
First Line	:	2713 VIRGINIA PKWY
Second Line	:	SUITE 200
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4917
Country	:	US
Telephone Number	:	972-569-8255
Fax Number	:	972-569-8355

Provider Business Practice Location Address
First Line	:	2713 VIRGINIA PKWY
Second Line	:	SUITE 200
City	:	MCKINNEY
State	:	TX
Zip	:	75071-4917
Country	:	US
Telephone Number	:	972-569-8255
Fax Number	:	972-569-8355

Authorized Official
Title or Position	:	OWNER
Name	:	JEANA PULLEN HERNDON
Credential	:	LPC
Telephone Number	:	972-569-8255

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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Directions to “A SAFE PLACE TO HEAL ” Practice Location

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