MEDICARE: MRS. EARNESTINE HAY MS, LPCI, 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	9186	TX
2	101YM0800X	Mental Health Counselor	63550	TX

General Provider Information

NPI Number	:	1346495116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EARNESTINE HAY MS, LPCI, LCDC

Provider Business Mailing Address
First Line	:	2000 NORTH LOOP W
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77018-8124
Country	:	US
Telephone Number	:	713-868-2908
Fax Number	:	713-864-2395

Provider Business Practice Location Address
First Line	:	2000 NORTH LOOP W
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77018-8124
Country	:	US
Telephone Number	:	713-868-2908
Fax Number	:	713-864-2395

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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