MEDICARE: MAP MY LIFE COUNSELING, PLLC

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	251S00000X	Community/Behavioral Health Agency	71543	TX

General Provider Information

NPI Number	:	1063875169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAP MY LIFE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	1110 NASA PKWY STE 545U
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY STE 545U
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3358
Country	:	US
Telephone Number	:	832-795-9521
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST / OWNER
Name	:	KRISTY L HAYES
Credential	:	M.A., LPC
Telephone Number	:	832-795-9521

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	04/05/2016

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