MEDICARE: CRAIG WARREN SPILLMAN PH.D.

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	9493	TX
2	106H00000X	Marriage & Family Therapist	001278	TX
3	101YM0800X	Mental Health Counselor	9493	TX

General Provider Information

NPI Number	:	1982680344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG WARREN SPILLMAN PH.D.

Provider Business Mailing Address
First Line	:	1300 W WALNUT HILL LN STE 200
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-3074
Country	:	US
Telephone Number	:	972-550-8369
Fax Number	:	972-550-8531

Provider Business Practice Location Address
First Line	:	1300 W WALNUT HILL LN
Second Line	:	SUITE 200
City	:	IRVING
State	:	TX
Zip	:	75038-3007
Country	:	US
Telephone Number	:	972-550-8369
Fax Number	:	972-550-8531

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/06/2024

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