MEDICARE: CHRISTIE MENA MA, NCC, 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	101YM0800X	Mental Health Counselor	75050	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-3513587	OTHER		TAX ID:

General Provider Information

NPI Number	:	1396252532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE MENA MA, NCC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 340395
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78734-0007
Country	:	US
Telephone Number	:	505-410-6666
Fax Number	:	505-410-6666

Provider Business Practice Location Address
First Line	:	1007 RANCH ROAD 620 S
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5634
Country	:	US
Telephone Number	:	505-410-6666
Fax Number	:

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

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	01/09/2018

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