MEDICARE: ALEX LEDERMAN 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	101YM0800X	Mental Health Counselor	67595	TX

General Provider Information

NPI Number	:	1952641383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX LEDERMAN LPC

Provider Business Mailing Address
First Line	:	1219 CAMPTON CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7008
Country	:	US
Telephone Number	:	713-409-0926
Fax Number	:	713-812-7525

Provider Business Practice Location Address
First Line	:	1219 CAMPTON CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-7008
Country	:	US
Telephone Number	:	713-409-0926
Fax Number	:	713-812-7525

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

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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