MEDICARE: ERIC T WELLMAN LPC, CRC

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	PC004735	PA
2	101YP2500X	Professional Counselor	PC004735	PA

General Provider Information

NPI Number	:	1144402413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC T WELLMAN LPC, CRC

Provider Business Mailing Address
First Line	:	RR 2 BOX 161
Second Line	:
City	:	VALLEY GROVE
State	:	WV
Zip	:	26060-8931
Country	:	US
Telephone Number	:	304-336-4282
Fax Number	:	304-336-4282

Provider Business Practice Location Address
First Line	:	4150 WASHINGTON RD
Second Line	:	SUITE 202
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2534
Country	:	US
Telephone Number	:	724-941-6640
Fax Number	:	724-941-6640

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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