MEDICARE: MS. SUE ANN WEBER PH. D, L.M.H.C.

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	101YM0800X	Mental Health Counselor	MH8614	ZZ

General Provider Information

NPI Number	:	1376873398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUE ANN WEBER PH. D, L.M.H.C.

Provider Business Mailing Address
First Line	:	6261 DUPONT STATION CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2567
Country	:	US
Telephone Number	:	904-394-5751
Fax Number	:	904-448-0349

Provider Business Practice Location Address
First Line	:	6261 DUPONT STATION CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2567
Country	:	US
Telephone Number	:	904-394-5751
Fax Number	:	904-448-0349

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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