MEDICARE: BRITTANY VICTORIA KLABUNDE 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	58132	TX

General Provider Information

NPI Number	:	1942970298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY VICTORIA KLABUNDE LCSW

Provider Business Mailing Address
First Line	:	1121 DALLAS DR STE 6
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-5100
Country	:	US
Telephone Number	:	940-483-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 DALLAS DR STE 6
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76205-5100
Country	:	US
Telephone Number	:	940-483-1789
Fax Number	:

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

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/17/2021

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