MEDICARE: MR. ANTHONY RANDOLPH METOYER JR. MA, NCC, LPC

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	101YP2500X	Professional Counselor	20077	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063639151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY RANDOLPH METOYER JR. MA, NCC, LPC

Provider Business Mailing Address
First Line	:	4507 STRADFORD PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1375
Country	:	US
Telephone Number	:	210-653-8154
Fax Number	:

Provider Business Practice Location Address
First Line	:	4507 STRADFORD PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1375
Country	:	US
Telephone Number	:	210-748-1257
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/21/2009

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