MEDICARE: VIA VIRTUAL ASSISTANT

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	101YM0800X	Mental Health Counselor	71046	TX

General Provider Information

NPI Number	:	1770971517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIA VIRTUAL ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 2683
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-0050
Country	:	US
Telephone Number	:	972-546-2874
Fax Number	:	972-468-9399

Provider Business Practice Location Address
First Line	:	9191 KYSER WAY
Second Line	:	SUITE 605
City	:	FRISCO
State	:	TX
Zip	:	75033-1953
Country	:	US
Telephone Number	:	972-546-2874
Fax Number	:	972-468-9399

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CAROLE GILMORE
Credential	:
Telephone Number	:	972-546-2874

Provider Enumeration Date	:	01/01/2015
Last Update Date	:	01/01/2015

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Directions to “VIA VIRTUAL ASSISTANT ” Practice Location

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