MEDICARE: MS. SUZANNE WAUGH SANDERS LPC, LMFT

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	LPC#1416	TX
2	106H00000X	Marriage & Family Therapist	LMFT#3839	TX

General Provider Information

NPI Number	:	1952686701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE WAUGH SANDERS LPC, LMFT

Provider Business Mailing Address
First Line	:	5716 LOMITA VERDE CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4201
Country	:	US
Telephone Number	:	512-301-0108
Fax Number	:

Provider Business Practice Location Address
First Line	:	5716 LOMITA VERDE CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4201
Country	:	US
Telephone Number	:	512-426-2601
Fax Number	:

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

Provider Enumeration Date	:	10/12/2011
Last Update Date	:	10/12/2011

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