MEDICARE: SUSANNE SLAY 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	01175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2206LC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1659599751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANNE SLAY LPC

Provider Business Mailing Address
First Line	:	2301 W ANDERSON LN STE 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1249
Country	:	US
Telephone Number	:	512-374-1030
Fax Number	:	512-374-1566

Provider Business Practice Location Address
First Line	:	2301 W ANDERSON LN STE 103
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1249
Country	:	US
Telephone Number	:	512-374-1030
Fax Number	:	512-374-1566

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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Directions to “ SUSANNE SLAY LPC” Practice Location

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