MEDICARE: MRS. TERESA JANE SPRAGGINS LCSW 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	1535	WV
2	104100000X	Social Worker	CP00816357	WV

General Provider Information

NPI Number	:	1588640734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA JANE SPRAGGINS LCSW LPC

Provider Business Mailing Address
First Line	:	40 LINDEN ST
Second Line	:
City	:	WESTOVER
State	:	WV
Zip	:	26501-4067
Country	:	US
Telephone Number	:	304-291-3858
Fax Number	:	304-291-3858

Provider Business Practice Location Address
First Line	:	40 LINDEN ST
Second Line	:
City	:	WESTOVER
State	:	WV
Zip	:	26501-4067
Country	:	US
Telephone Number	:	304-291-3858
Fax Number	:	304-291-3858

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	12/01/2011

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