MEDICARE: SUSAN COVELL LCSW

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	1041C0700X	Clinical Social Worker	13598	TX

General Provider Information

NPI Number	:	1982710729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN COVELL LCSW

Provider Business Mailing Address
First Line	:	4131 SPICEWOOD SPRINGS ROAD
Second Line	:	SUITE I-2
City	:	AUSTIN
State	:	TX
Zip	:	78759-8659
Country	:	US
Telephone Number	:	512-345-4364
Fax Number	:	512-345-7866

Provider Business Practice Location Address
First Line	:	4131 SPICEWOOD SPRINGS ROAD
Second Line	:	SUITE I-2
City	:	AUSTIN
State	:	TX
Zip	:	78759-8659
Country	:	US
Telephone Number	:	512-345-4364
Fax Number	:	512-345-7866

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/21/2022

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