MEDICARE: TAJA TOWNE 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	64502	TX

General Provider Information

NPI Number	:	1942922125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAJA TOWNE LCSW

Provider Business Mailing Address
First Line	:	336 OAKHURST SCENIC DR APT 2160
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2064
Country	:	US
Telephone Number	:	520-258-8884
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CENTRAL EXPRESSWAY
Second Line	:	5TH FLOOR, SUITE 121
City	:	PLANO
State	:	TX
Zip	:	75074
Country	:	US
Telephone Number	:	972-895-8376
Fax Number	:

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

Provider Enumeration Date	:	09/14/2022
Last Update Date	:	09/14/2022

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