MEDICARE: JOHN PATRICK CHERVENAK M.R.C., C.R.C., L.P.

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	2004011118	MO

General Provider Information

NPI Number	:	1649385469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PATRICK CHERVENAK M.R.C., C.R.C., L.P.

Provider Business Mailing Address
First Line	:	1631 SEIFERT DR
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2555
Country	:	US
Telephone Number	:	573-686-6453
Fax Number	:	573-686-6504

Provider Business Practice Location Address
First Line	:	1906 GREENWOOD DR # B
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-2430
Country	:	US
Telephone Number	:	573-778-0705
Fax Number	:	573-778-0925

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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