MEDICARE: BALDEMAR DE HOYOS LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10916	TX

General Provider Information

NPI Number	:	1215826474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALDEMAR DE HOYOS LCDC

Provider Business Mailing Address
First Line	:	1025 DANFORTH CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-6351
Country	:	US
Telephone Number	:	972-904-9202
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 S COLLINS ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76014-1224
Country	:	US
Telephone Number	:	972-904-9202
Fax Number	:

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

Provider Enumeration Date	:	07/01/2025
Last Update Date	:	04/08/2026

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