MEDICARE: LORETTA MAE SKELTON PLPC

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	2007002489	MO

General Provider Information

NPI Number	:	1043342389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA MAE SKELTON PLPC

Provider Business Mailing Address
First Line	:	PO BOX 612
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-0612
Country	:	US
Telephone Number	:	573-216-2216
Fax Number	:	573-348-9975

Provider Business Practice Location Address
First Line	:	5740 HIGHWAY 54
Second Line	:	LOWER LEVEL
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3086
Country	:	US
Telephone Number	:	573-348-9979
Fax Number	:	573-348-9975

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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