MEDICARE: MS. TERESA SUE SMITH LPCC

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	0963	NM

General Provider Information

NPI Number	:	1184978660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA SUE SMITH LPCC

Provider Business Mailing Address
First Line	:	PO BOX 3167
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-6167
Country	:	US
Telephone Number	:	575-621-6365
Fax Number	:

Provider Business Practice Location Address
First Line	:	7264 NORMANDY DR
Second Line	:	FT. RILEY
City	:	JUNCTION CITY
State	:	KS
Zip	:	66442-4461
Country	:	US
Telephone Number	:	573-239-1883
Fax Number	:

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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