MEDICARE: SYMBIOTIC COUNSELING SERVICES, LLC

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	2289	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104089762	OTHER	AL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1013135383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYMBIOTIC COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	2306 2ND AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3808
Country	:	US
Telephone Number	:	205-601-8665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 2ND AVE N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3808
Country	:	US
Telephone Number	:	205-601-8665
Fax Number	:

Authorized Official
Title or Position	:	OWNER THERAPIST
Name	:	JULIA PAMPLIN VAUGHNE
Credential	:	NCC, LPC
Telephone Number	:	205-601-8665

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/22/2008

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