MEDICARE: SARAH WEI OU-YOUNG MA, 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	14826	TX

General Provider Information

NPI Number	:	1760425425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WEI OU-YOUNG MA, LPC

Provider Business Mailing Address
First Line	:	11942 EUM LANE
Second Line	:
City	:	NORTH ZULCH
State	:	TX
Zip	:	77872
Country	:	US
Telephone Number	:	979-220-0150
Fax Number	:	936-399-9985

Provider Business Practice Location Address
First Line	:	400 N WASHINGTON AVE
Second Line	:	SUITE 1
City	:	BRYAN
State	:	TX
Zip	:	77803-5310
Country	:	US
Telephone Number	:	979-220-0150
Fax Number	:	936-399-9985

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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