| |
219 Gene Autry Dr Ste A Tioga TX 76271-3652 | |
(940) 206-3345 | |
Not Available |
Full Name | |
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Speciality | Social Worker |
Location | 219 Gene Autry Dr Ste A, Tioga, Texas |
Authorized Official Name and Position | Theresa Marie Donsbach (THERAPIST) |
Authorized Official Contact | 7275104111 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 313 Tioga TX 76271-0313 Ph: (940) 206-3345 | 219 Gene Autry Dr Ste A Tioga TX 76271-3652 Ph: (940) 206-3345 |
NPI Number | 1538735691 |
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Provider Enumeration Date | 05/31/2021 |
Last Update Date | 10/22/2024 |
Certification Date | 10/22/2024 |
Medicare PECOS PAC ID | 6406252816 |
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Medicare Enrollment ID | O20210910000819 |
Identifier | Type | State | Issuer |
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1538735691 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Theresa Marie Donsbach |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1972904480 PECOS PAC ID: 4587060991 Enrollment ID: I20210910000902 |