MEDICARE: M & M COUNSELING & ASSESSMENT SERVICES, P.A.

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	103TC0700X	Clinical Psychologist	25043	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992178396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & M COUNSELING & ASSESSMENT SERVICES, P.A.

Provider Business Mailing Address
First Line	:	2501 DENA DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5014
Country	:	US
Telephone Number	:	325-223-0786
Fax Number	:	325-617-4196

Provider Business Practice Location Address
First Line	:	2501 DENA DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5014
Country	:	US
Telephone Number	:	325-223-0786
Fax Number	:	325-617-4196

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM ATTERBURY MONTGOMERY
Credential	:	PH.D.
Telephone Number	:	325-223-0786

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	11/06/2015

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