MEDICARE: MS. SUSAN KAY GUILLORY MS, LPC, NCC

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	3571	LA

General Provider Information

NPI Number	:	1982842324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN KAY GUILLORY MS, LPC, NCC

Provider Business Mailing Address
First Line	:	409 ALICE DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-4808
Country	:	US
Telephone Number	:	337-344-1117
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 HEYMANN BLVD
Second Line	:	#207
City	:	LAFAYETTE
State	:	LA
Zip	:	70503-2363
Country	:	US
Telephone Number	:	337-344-1117
Fax Number	:

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

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	01/22/2009

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