MEDICARE: MS. SERETHA MANOR CARTER LPC

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	70110	TX

General Provider Information

NPI Number	:	1750897450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SERETHA MANOR CARTER LPC

Provider Business Mailing Address
First Line	:	10B CHISHOLM TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5043
Country	:	US
Telephone Number	:	512-704-2003
Fax Number	:

Provider Business Practice Location Address
First Line	:	10B CHISHOLM TRL
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5043
Country	:	US
Telephone Number	:	512-704-2003
Fax Number	:

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

Provider Enumeration Date	:	12/18/2017
Last Update Date	:	12/18/2017

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