MEDICARE: MRS. AMY L HATFIELD 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	62946	TX

General Provider Information

NPI Number	:	1962647909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY L HATFIELD LPC

Provider Business Mailing Address
First Line	:	4841 HEBER SPRINGS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5901
Country	:	US
Telephone Number	:	469-371-4516
Fax Number	:	940-380-8756

Provider Business Practice Location Address
First Line	:	4841 HEBER SPRINGS TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5901
Country	:	US
Telephone Number	:	469-371-4516
Fax Number	:	940-380-8756

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

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	03/02/2010

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