MEDICARE: CHIVONNE LAWRENCE BSECED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	171W00000X	Contractor
4	174400000X	Specialist

General Provider Information

NPI Number	:	1649595778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIVONNE LAWRENCE BSECED

Provider Business Mailing Address
First Line	:	3517 NW 54TH ST
Second Line	:	APT 235
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 NW 54TH ST
Second Line	:	APT 235
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1927
Country	:	US
Telephone Number	:	405-935-3517
Fax Number	:

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

Provider Enumeration Date	:	03/31/2010
Last Update Date	:	03/31/2010

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