MEDICARE: MS. SUSAN ANN NETHERY 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	17954	TX

General Provider Information

NPI Number	:	1487707725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN ANN NETHERY LPC

Provider Business Mailing Address
First Line	:	199 BUFFALO LN
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-5488
Country	:	US
Telephone Number	:	325-655-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 E TWOHIG AVE
Second Line	:	SUITE 300
City	:	SAN ANGELO
State	:	TX
Zip	:	76903-6433
Country	:	US
Telephone Number	:	325-657-0718
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/29/2007

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