MEDICARE: MS. CAROLYN FARISH GROOS

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	19983	TX

General Provider Information

NPI Number	:	1992807416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLYN FARISH GROOS

Provider Business Mailing Address
First Line	:	PO BOX 1711
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-1711
Country	:	US
Telephone Number	:	512-680-8787
Fax Number	:	830-868-2099

Provider Business Practice Location Address
First Line	:	3536 BEE CAVE RD
Second Line	:	SUITE 100
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-6654
Country	:	US
Telephone Number	:	512-680-8787
Fax Number	:	512-327-7398

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

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	07/08/2007

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