MEDICARE: YOLANDA R CALDERON 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	16720	TX

General Provider Information

NPI Number	:	1013946177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA R CALDERON LPC

Provider Business Mailing Address
First Line	:	1321 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5868
Country	:	US
Telephone Number	:	817-521-3517
Fax Number	:	817-417-0441

Provider Business Practice Location Address
First Line	:	1321 E PIONEER PKWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76010-5868
Country	:	US
Telephone Number	:	817-521-3517
Fax Number	:	817-417-0441

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/08/2007

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