MEDICARE: MARY CATHERINE LINGWALL

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	374J00000X	Doula

General Provider Information

NPI Number	:	1770917312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CATHERINE LINGWALL

Provider Business Mailing Address
First Line	:	1404 MICHIGAN ST
Second Line	:	#GA
City	:	HOUSTON
State	:	TX
Zip	:	77006-1824
Country	:	US
Telephone Number	:	214-803-2495
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 MARONEAL ST
Second Line	:	UNIT 1737
City	:	HOUSTON
State	:	TX
Zip	:	77030-3242
Country	:	US
Telephone Number	:	855-455-2229
Fax Number	:

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

Provider Enumeration Date	:	08/31/2013
Last Update Date	:	08/31/2013

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