MEDICARE: DR. ROBERT O CHOATE L.P.C.

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	12667	TX

General Provider Information

NPI Number	:	1265410039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT O CHOATE L.P.C.

Provider Business Mailing Address
First Line	:	3205 N UNIVERSITY DR
Second Line	:	#206
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2683
Country	:	US
Telephone Number	:	936-564-9757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 N UNIVERSITY DR
Second Line	:	206
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2683
Country	:	US
Telephone Number	:	936-564-9757
Fax Number	:

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	01/27/2014

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