MEDICARE: MS. SANDRA GOODMAN CORNWELL 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	09980	TX

General Provider Information

NPI Number	:	1982788709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA GOODMAN CORNWELL L.P.C.

Provider Business Mailing Address
First Line	:	2925 PALMER HWY
Second Line	:	SUITE C
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-6814
Country	:	US
Telephone Number	:	409-935-7900
Fax Number	:	409-943-5220

Provider Business Practice Location Address
First Line	:	2925 PALMER HWY
Second Line	:	SUITE C
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-6814
Country	:	US
Telephone Number	:	409-935-7900
Fax Number	:	409-943-5220

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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