MEDICARE: MRS. SUE ELLEN PLUM M.A.

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

General Provider Information

NPI Number	:	1457599425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUE ELLEN PLUM M.A.

Provider Business Mailing Address
First Line	:	10011 CORNER RD
Second Line	:
City	:	MERCERSBURG
State	:	PA
Zip	:	17236-9706
Country	:	US
Telephone Number	:	717-328-2590
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 S 8TH ST
Second Line	:	SUITE 108
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-2755
Country	:	US
Telephone Number	:	717-262-2183
Fax Number	:	717-262-2486

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

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	01/29/2009

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