MEDICARE: FIRE SHEEP INC

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	1041C0700X	Clinical Social Worker	19481	TX

General Provider Information

NPI Number	:	1356574677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRE SHEEP INC

Provider Business Mailing Address
First Line	:	4902 GROVER AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2629
Country	:	US
Telephone Number	:	512-454-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4902 GROVER AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2629
Country	:	US
Telephone Number	:	512-454-7779
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA STUESSER
Credential	:	LCSW
Telephone Number	:	512-454-7779

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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Directions to “FIRE SHEEP INC ” Practice Location

Language	Start Address	Practice Location

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