MEDICARE: CATHERINE REESE FLETCHER 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	LPC009031	GA

General Provider Information

NPI Number	:	1922458967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE REESE FLETCHER LPC

Provider Business Mailing Address
First Line	:	5565 JUMPING GULLY RD
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31601-2313
Country	:	US
Telephone Number	:	229-460-4832
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 GREEN CIR STE B
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2784
Country	:	US
Telephone Number	:	229-244-9688
Fax Number	:

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/21/2016

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