MEDICARE: SUSAN TODD 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	002502	MO

General Provider Information

NPI Number	:	1417114372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN TODD LPC

Provider Business Mailing Address
First Line	:	RR 1 BOX 108
Second Line	:
City	:	MALTA BEND
State	:	MO
Zip	:	65339-9719
Country	:	US
Telephone Number	:	660-595-2318
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 1 BOX 108
Second Line	:
City	:	MALTA BEND
State	:	MO
Zip	:	65339-9719
Country	:	US
Telephone Number	:	660-595-2318
Fax Number	:

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

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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