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7919 Osborn Pkwy Plano TX 75024-5873 | |
| (469) 573-1726 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 7919 Osborn Pkwy, Plano, Texas |
| Authorized Official Name and Position | Debra K Iversen (OWNER) |
| Authorized Official Contact | 4695731726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7919 Osborn Pkwy Plano TX 75024-5873 Ph: (469) 573-1726 | 7919 Osborn Pkwy Plano TX 75024-5873 Ph: (469) 573-1726 |
| NPI Number | 1093360315 |
|---|---|
| Provider Enumeration Date | 08/04/2019 |
| Last Update Date | 09/14/2020 |
| Certification Date | 09/14/2020 |
| Medicare PECOS PAC ID | 1456782978 |
|---|---|
| Medicare Enrollment ID | O20200515001518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093360315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Debra Iversen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811911522 PECOS PAC ID: 8729141056 Enrollment ID: I20200515001567 |
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