MEDICARE: SARAH NEELLEY 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

General Provider Information

NPI Number	:	1730880832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH NEELLEY LPC

Provider Business Mailing Address
First Line	:	2501 AUSTIN AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7417
Country	:	US
Telephone Number	:	254-500-3411
Fax Number	:	254-477-7004

Provider Business Practice Location Address
First Line	:	2501 AUSTIN AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7417
Country	:	US
Telephone Number	:	254-500-3411
Fax Number	:	254-477-7004

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	04/21/2024

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Directions to “ SARAH NEELLEY LPC” Practice Location

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