MEDICARE: JESSICA LYNN SUGAMELE 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	68042	TX
2	101YM0800X	Mental Health Counselor	LPC-6091	CO

General Provider Information

NPI Number	:	1801177100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN SUGAMELE LPC

Provider Business Mailing Address
First Line	:	2145 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-7908
Country	:	US
Telephone Number	:	512-436-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-7908
Country	:	US
Telephone Number	:	512-436-8013
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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