1932256484 NPI number — MRS. SYLVIA HURST MCTAGUE LPC

Table of content: MRS. SYLVIA HURST MCTAGUE LPC (NPI 1932256484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932256484 NPI number — MRS. SYLVIA HURST MCTAGUE LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCTAGUE
Provider First Name:
SYLVIA
Provider Middle Name:
HURST
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HURST
Provider Other First Name:
SYLVIA
Provider Other Middle Name:
LENORE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932256484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 INTERSTATE 40 WEST
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-2529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-359-5697
Provider Business Mailing Address Fax Number:
806-354-8680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 INTERSTATE 40 WEST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-359-5697
Provider Business Practice Location Address Fax Number:
806-354-8680
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  936 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 979 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189624 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2161LC . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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