MEDICARE: MRS. REBECCA MCCONNELL MA, 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	101YP2500X	Professional Counselor	62921	TX

General Provider Information

NPI Number	:	1306106620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA MCCONNELL MA, LPC

Provider Business Mailing Address
First Line	:	2500 W WILLIAM CANNON DR
Second Line	:	SUITE 601
City	:	AUSTIN
State	:	TX
Zip	:	78745-5257
Country	:	US
Telephone Number	:	512-608-2563
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 S. MOPAC EXPY
Second Line	:	#1412
City	:	AUSTIN
State	:	TX
Zip	:	78749
Country	:	US
Telephone Number	:	512-608-2563
Fax Number	:

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

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/21/2012

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