MEDICARE: MRS. LEANN L SORRELS 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	14700	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6071LC	OTHER	TX	PROVIDER NUMBER

General Provider Information

NPI Number	:	1316079338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEANN L SORRELS LPC

Provider Business Mailing Address
First Line	:	4020 TULANE DR
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-5533
Country	:	US
Telephone Number	:	806-690-4545
Fax Number	:	806-356-6121

Provider Business Practice Location Address
First Line	:	6666 W AMARILLO BLVD
Second Line	:	SUITE 18
City	:	AMARILLO
State	:	TX
Zip	:	79106-1756
Country	:	US
Telephone Number	:	806-690-4545
Fax Number	:	806-356-6120

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/09/2007

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