MEDICARE: IC COUNSELING AND CONSULTATION

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

General Provider Information

NPI Number	:	1427749498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IC COUNSELING AND CONSULTATION

Provider Business Mailing Address
First Line	:	12119 GRAND ARCHES LN
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3686
Country	:	US
Telephone Number	:	281-513-2279
Fax Number	:

Provider Business Practice Location Address
First Line	:	12119 GRAND ARCHES LN
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3686
Country	:	US
Telephone Number	:	281-513-2279
Fax Number	:

Authorized Official
Title or Position	:	LPC-S
Name	:	IRMA GUARDIOLA CASTILLO
Credential	:
Telephone Number	:	281-513-2279

Provider Enumeration Date	:	05/18/2023
Last Update Date	:	05/18/2023

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Directions to “IC COUNSELING AND CONSULTATION ” Practice Location

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