MEDICARE: TANYA SKELLY LPC UNDERSUPERVISION

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

General Provider Information

NPI Number	:	1275852568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA SKELLY LPC UNDERSUPERVISION

Provider Business Mailing Address
First Line	:	900 NW 10TH STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109
Country	:	US
Telephone Number	:	405-528-7373
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 NW 10TH STREET
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115
Country	:	US
Telephone Number	:	405-528-7373
Fax Number	:

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	10/31/2011

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