MEDICARE: MS. SUSAN RUTLEDGE CREWS 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	8118	TX

General Provider Information

NPI Number	:	1356673735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN RUTLEDGE CREWS LPC

Provider Business Mailing Address
First Line	:	812 KERN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2403
Country	:	US
Telephone Number	:	15-542-0908
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 KERN DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-2403
Country	:	US
Telephone Number	:	15-542-0908
Fax Number	:

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

Provider Enumeration Date	:	02/09/2010
Last Update Date	:	02/09/2010

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