MEDICARE: ROXANA CONROY 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	2123	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2123	OTHER	AL	LPC

General Provider Information

NPI Number	:	1952301913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANA CONROY LPC

Provider Business Mailing Address
First Line	:	3001 SCENIC HWY
Second Line	:
City	:	GADSDEN
State	:	AL
Zip	:	35904-3047
Country	:	US
Telephone Number	:	256-546-9265
Fax Number	:	256-549-0376

Provider Business Practice Location Address
First Line	:	1302 NOBLE STREET
Second Line	:	STE 3D
City	:	ANNISTON
State	:	AL
Zip	:	36201-4678
Country	:	US
Telephone Number	:	256-546-9265
Fax Number	:	256-549-0376

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/13/2008

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