MEDICARE: MRS. DELORES S. CONEY 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	101YM0800X	Mental Health Counselor	15455	TX

General Provider Information

NPI Number	:	1225159445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELORES S. CONEY LPC

Provider Business Mailing Address
First Line	:	415 LAKE AIR DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-5837
Country	:	US
Telephone Number	:	254-751-1606
Fax Number	:	254-772-6118

Provider Business Practice Location Address
First Line	:	415 LAKE AIR DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-5837
Country	:	US
Telephone Number	:	254-751-1606
Fax Number	:	254-772-6118

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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