MEDICARE: SHILOH 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	101YM0800X	Mental Health Counselor	16814	TX

General Provider Information

NPI Number	:	1063758407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHILOH COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	3602 SLIDE RD STE 32J
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-2549
Country	:	US
Telephone Number	:	806-794-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 SLIDE RD STE 32J
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79414-2549
Country	:	US
Telephone Number	:	806-794-3232
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MRS. SARAH JANET MCDOWELL
Credential	:	LPC
Telephone Number	:	806-794-3232

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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