MEDICARE: PATRICIA L. MCCORMICK 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	2518	AL

General Provider Information

NPI Number	:	1942323019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA L. MCCORMICK LPC

Provider Business Mailing Address
First Line	:	6 OFFICE PARK CIR STE 100
Second Line	:
City	:	MOUNTAIN BRK
State	:	AL
Zip	:	35223-2664
Country	:	US
Telephone Number	:	205-313-1793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 SHADES CREST RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1412
Country	:	US
Telephone Number	:	205-979-4670
Fax Number	:	205-979-4670

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	08/01/2011

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