MEDICARE: MS. SUSAN B. KRAYER 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	3174	OR

General Provider Information

NPI Number	:	1063741791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN B. KRAYER LPC

Provider Business Mailing Address
First Line	:	PO BOX 7593
Second Line	:
City	:	BROOKINGS
State	:	OR
Zip	:	97415-0347
Country	:	US
Telephone Number	:	541-736-3882
Fax Number	:	541-736-3882

Provider Business Practice Location Address
First Line	:	97829 SHOPPING CENTER AVE
Second Line	:
City	:	HARBOR
State	:	OR
Zip	:	97415-9135
Country	:	US
Telephone Number	:	541-735-2126
Fax Number	:	541-736-3882

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	03/03/2015

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