MEDICARE: ANNE JERNIGAN VELEZ ED.S., L.P.C.

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	LPC006083	GA
2	103TS0200X	School Psychologist		GA

General Provider Information

NPI Number	:	1679919369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE JERNIGAN VELEZ ED.S., L.P.C.

Provider Business Mailing Address
First Line	:	4158 D YOUVILLE TRCE
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-1433
Country	:	US
Telephone Number	:	706-483-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	4158 D YOUVILLE TRCE
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-1433
Country	:	US
Telephone Number	:	706-483-2799
Fax Number	:

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

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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