MEDICARE: SEAN FITZPATRICK PHD, 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	101YM0800X	Mental Health Counselor	63824	TX

General Provider Information

NPI Number	:	1700413598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN FITZPATRICK PHD, LPC

Provider Business Mailing Address
First Line	:	5200 MONTROSE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-6547
Country	:	US
Telephone Number	:	713-503-5855
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 MONTROSE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-6547
Country	:	US
Telephone Number	:	713-503-5855
Fax Number	:

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

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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