MEDICARE: DEBORAH SUE MARLIN 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	09663	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6149LC	OTHER	TX	BLUE CROSS BLUE SHIELD
2	09663	OTHER	TX	LPC LICENSE

General Provider Information

NPI Number	:	1861582538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH SUE MARLIN L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 298
Second Line	:
City	:	BANGS
State	:	TX
Zip	:	76823-0298
Country	:	US
Telephone Number	:	325-642-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 COUNTY ROAD 102
Second Line	:
City	:	SANTA ANNA
State	:	TX
Zip	:	76878-5101
Country	:	US
Telephone Number	:	325-642-8589
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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