MEDICARE: SONYA CHARLTON COUNSELING LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	771	NE
2	101YM0800X	Mental Health Counselor	702	NE

General Provider Information

NPI Number	:	1386933224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONYA CHARLTON COUNSELING LLC

Provider Business Mailing Address
First Line	:	9807 N TWIN LKS
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-9509
Country	:	US
Telephone Number	:	308-520-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	9807 N TWIN LKS
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-9509
Country	:	US
Telephone Number	:	308-520-6110
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MS. SONYA ANN CHARLTON
Credential	:	LIMHP, LADC
Telephone Number	:	308-520-6110

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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