MEDICARE: MS. AUDREY MAY STEAKLEY 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	63080	TX

General Provider Information

NPI Number	:	1487885711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY MAY STEAKLEY LPC

Provider Business Mailing Address
First Line	:	203 SANTA RITA DR
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79763-2943
Country	:	US
Telephone Number	:	432-335-0794
Fax Number	:	432-335-0794

Provider Business Practice Location Address
First Line	:	203 SANTA RITA DR
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79763-2943
Country	:	US
Telephone Number	:	432-335-0794
Fax Number	:	432-335-0794

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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