MEDICARE: MS. BERNADETTE C TOURTUAL LISW-CP

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	1041C0700X	Clinical Social Worker	8537	SC

General Provider Information

NPI Number	:	1881685501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BERNADETTE C TOURTUAL LISW-CP

Provider Business Mailing Address
First Line	:	4826 HABERSHAM LN
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8580
Country	:	US
Telephone Number	:	843-851-1930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 EVATT LANE SUITE 106
Second Line	:	PALMETTO BEHAVIORAL HEALTH SOLUTIONS LLC
City	:	CHARLESTON
State	:	SC
Zip	:	29405
Country	:	US
Telephone Number	:	843-745-5189
Fax Number	:	843-747-8080

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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