MEDICARE: MARY MICHELE PEPPER LPC, 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	101Y00000X	Counselor	3270	LA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	3270	LA
3	101YM0800X	Mental Health Counselor	3270	LA
4	101YP2500X	Professional Counselor	3270	LA
5	101YS0200X	School Counselor	3270	LA
6	106H00000X	Marriage & Family Therapist	1045	LA

General Provider Information

NPI Number	:	1619275484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MICHELE PEPPER LPC, LMFT

Provider Business Mailing Address
First Line	:	8627 PLUM LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3609
Country	:	US
Telephone Number	:	318-918-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	8627 PLUM LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3609
Country	:	US
Telephone Number	:	318-918-8905
Fax Number	:

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

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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