MEDICARE: JULIA KATHLEEN PIRTLE 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	10002	TX

General Provider Information

NPI Number	:	1386746584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA KATHLEEN PIRTLE LPC

Provider Business Mailing Address
First Line	:	409 RUNNELS ST
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-2529
Country	:	US
Telephone Number	:	432-264-2650
Fax Number	:	432-268-9897

Provider Business Practice Location Address
First Line	:	412 W 5TH ST
Second Line	:
City	:	DENVER CITY
State	:	TX
Zip	:	79323-2761
Country	:	US
Telephone Number	:	806-592-8226
Fax Number	:	806-592-8259

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	07/09/2007

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