MEDICARE: PAULA SYKES MS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1154576908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA SYKES MS

Provider Business Mailing Address
First Line	:	8401 OUTER RD
Second Line	:
City	:	MOUNTAIN GROVE
State	:	MO
Zip	:	65711-2516
Country	:	US
Telephone Number	:	417-926-1500
Fax Number	:	417-926-1538

Provider Business Practice Location Address
First Line	:	8401 OUTER RD
Second Line	:
City	:	MOUNTAIN GROVE
State	:	MO
Zip	:	65711-2516
Country	:	US
Telephone Number	:	417-926-1500
Fax Number	:	417-926-1538

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

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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