MEDICARE: DR. DARLENE A TREESE PHD

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	101Y00000X	Counselor	LPC 0718	AZ
2	101Y00000X	Counselor	RC 00048608	WA
3	101Y00000X	Counselor	PMH 690	FL

General Provider Information

NPI Number	:	1013976406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARLENE A TREESE PHD

Provider Business Mailing Address
First Line	:	PO BOX 12836
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32317-2836
Country	:	US
Telephone Number	:	850-201-0073
Fax Number	:	850-668-6963

Provider Business Practice Location Address
First Line	:	2804 REMINGTON GREEN CIR
Second Line	:	SUITE 3
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8707
Country	:	US
Telephone Number	:	850-201-0073
Fax Number	:

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	08/14/2007

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