MEDICARE: JOSEPH LEVOID JEFFERSON 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	5857	TX

General Provider Information

NPI Number	:	1821026097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LEVOID JEFFERSON LPC

Provider Business Mailing Address
First Line	:	7011 BISSONNET ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77074-6009
Country	:	US
Telephone Number	:	713-271-1822
Fax Number	:	713-777-5957

Provider Business Practice Location Address
First Line	:	7011 BISSONNET ST
Second Line	:	SUITE B
City	:	HOUSTON
State	:	TX
Zip	:	77074-6009
Country	:	US
Telephone Number	:	713-271-1822
Fax Number	:	713-777-5957

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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