MEDICARE: MESA VIEW COUNSELING AND CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1326914623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA VIEW COUNSELING AND CONSULTING PLLC

Provider Business Mailing Address
First Line	:	3000 JOE DIMAGGIO BLVD STE 1
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3989
Country	:	US
Telephone Number	:	512-400-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 JOE DIMAGGIO BLVD STE 1
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3989
Country	:	US
Telephone Number	:	512-400-0019
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE DICKERSON
Credential	:	LMFT
Telephone Number	:	512-400-0196

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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