MEDICARE: MS. SANDRA LYALL L.M.H.C., NCC, CEAP

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	3834	MA

General Provider Information

NPI Number	:	1922139146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LYALL L.M.H.C., NCC, CEAP

Provider Business Mailing Address
First Line	:	7 EDGEWOOD DR
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1216
Country	:	US
Telephone Number	:	413-525-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MAPLE ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1979
Country	:	US
Telephone Number	:	413-794-6604
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	04/09/2008

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