MEDICARE: SHANE D TRATECHAUD 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	LPC009280	GA

General Provider Information

NPI Number	:	1881941987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE D TRATECHAUD LPC

Provider Business Mailing Address
First Line	:	6 WILTON LANE
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31410
Country	:	US
Telephone Number	:	912-220-4247
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 FOREST PARK DR STE E
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-2507
Country	:	US
Telephone Number	:	912-602-0901
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	03/17/2018

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