MEDICARE: LIN SUTTON PH.D, 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	9788	TX

General Provider Information

NPI Number	:	1376605691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIN SUTTON PH.D, LPC

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD
Second Line	:	SUITE 218N
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4211
Country	:	US
Telephone Number	:	210-298-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 PARK TEN BLVD
Second Line	:	SUITE 218N
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4211
Country	:	US
Telephone Number	:	210-298-2870
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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