MEDICARE: MS. JANIE ALICE SWEETEN 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	1384	OK

General Provider Information

NPI Number	:	1437205812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANIE ALICE SWEETEN L.P.C.

Provider Business Mailing Address
First Line	:	3456 SCENIC DR
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-5518
Country	:	US
Telephone Number	:	918-786-3793
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 E 3RD ST
Second Line	:
City	:	GROVE
State	:	OK
Zip	:	74344-7006
Country	:	US
Telephone Number	:	918-786-3793
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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