MEDICARE: PAUL WILSON SLAUGHTER LMFT

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	106H00000X	Marriage & Family Therapist	221	CO

General Provider Information

NPI Number	:	1265450241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL WILSON SLAUGHTER LMFT

Provider Business Mailing Address
First Line	:	235 WEST ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-1854
Country	:	US
Telephone Number	:	970-482-3107
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 CANYON AVE STE B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2677
Country	:	US
Telephone Number	:	970-988-7042
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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