MEDICARE: AUDREY M SUDBERRY 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	101YM0800X	Mental Health Counselor	C05000407	OH

General Provider Information

NPI Number	:	1538326129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY M SUDBERRY LPC

Provider Business Mailing Address
First Line	:	26241 LAKE SHORE BLVD
Second Line	:	#2164
City	:	EUCLID
State	:	OH
Zip	:	44132-1177
Country	:	US
Telephone Number	:	216-923-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	1991 LEE RD
Second Line	:	#10 ABEL COUNSELING & ASSOCS
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1177
Country	:	US
Telephone Number	:	216-923-0823
Fax Number	:

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/22/2008

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