MEDICARE: ERIN MARIE FAVORITE M. ED., 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1477865590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARIE FAVORITE M. ED., LPC

Provider Business Mailing Address
First Line	:	9212 N KELLEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-2419
Country	:	US
Telephone Number	:	405-242-5070
Fax Number	:	405-242-5071

Provider Business Practice Location Address
First Line	:	9212 N KELLEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-2419
Country	:	US
Telephone Number	:	405-242-5070
Fax Number	:	405-242-5071

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

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/08/2014

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