MEDICARE: MR. MAC ENROE MCQUADE LPC, LCDC

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	8649	TX
2	101YP2500X	Professional Counselor	59576	TX
3	101YM0800X	Mental Health Counselor	59576	TX

General Provider Information

NPI Number	:	1194868950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAC ENROE MCQUADE LPC, LCDC

Provider Business Mailing Address
First Line	:	1430 COLLIER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2911
Country	:	US
Telephone Number	:	512-445-7787
Fax Number	:	512-440-4059

Provider Business Practice Location Address
First Line	:	3000 OAK SPRINGS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2531
Country	:	US
Telephone Number	:	512-804-3513
Fax Number	:	512-804-3590

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/06/2007

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