MEDICARE: SANDRA SCOTT PERKINS 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	18145	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6198LC	OTHER	TX	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1467572453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA SCOTT PERKINS LPC

Provider Business Mailing Address
First Line	:	PO BOX 51272
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79159-1272
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

Provider Business Practice Location Address
First Line	:	4211 W INTERSTATE 40
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-6053
Country	:	US
Telephone Number	:	806-374-5950
Fax Number	:	806-358-4345

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

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	07/08/2007

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