MEDICARE: AMBROES DENICE PASS-TURNER

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	LPC003753	GA

General Provider Information

NPI Number	:	1760654172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBROES DENICE PASS-TURNER

Provider Business Mailing Address
First Line	:	2210 WYNNTON RD STE 124
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-5809
Country	:	US
Telephone Number	:	706-327-9778
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 WYNNTON RD STE 124
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-5809
Country	:	US
Telephone Number	:	706-327-9778
Fax Number	:

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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