MEDICARE: DEVIN MICHAEL GILES LCSW

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	1041C0700X	Clinical Social Worker	60281	TX

General Provider Information

NPI Number	:	1942782933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN MICHAEL GILES LCSW

Provider Business Mailing Address
First Line	:	7303 WOOD HOLLOW DR APT 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2538
Country	:	US
Telephone Number	:	512-241-8135
Fax Number	:

Provider Business Practice Location Address
First Line	:	2906 SAN GABRIEL ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-3533
Country	:	US
Telephone Number	:	737-241-8135
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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