MEDICARE: LOREN HERVEY LPC

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	67668	TX

General Provider Information

NPI Number	:	1942647193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOREN HERVEY LPC

Provider Business Mailing Address
First Line	:	3824 CEDAR SPRINGS RD # 396
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4136
Country	:	US
Telephone Number	:	214-535-9650
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N STEMMONS FWY STE 147
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75207-2113
Country	:	US
Telephone Number	:	214-535-9650
Fax Number	:

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

Provider Enumeration Date	:	05/29/2013
Last Update Date	:	05/29/2013

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