MEDICARE: YADIRA G PUENTE LPC-S

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	62172	TX

General Provider Information

NPI Number	:	1255719449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YADIRA G PUENTE LPC-S

Provider Business Mailing Address
First Line	:	3201 CHERRY RIDGE ST STE C318
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4826
Country	:	US
Telephone Number	:	210-387-2218
Fax Number	:	833-571-1220

Provider Business Practice Location Address
First Line	:	3201 CHERRY RIDGE DR STE C318
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4826
Country	:	US
Telephone Number	:	210-387-2218
Fax Number	:	833-571-1220

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

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	07/13/2022

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