MEDICARE: DIANIDA AGUILAR MA, LPC ASSOCIATE

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	96746	TX

General Provider Information

NPI Number	:	1568281442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANIDA AGUILAR MA, LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	1001 CYPRESS CREEK RD STE 403
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-4470
Country	:	US
Telephone Number	:	512-323-6994
Fax Number	:	512-323-9490

Provider Business Practice Location Address
First Line	:	113 S RIVER ST STE 105
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-5740
Country	:	US
Telephone Number	:	737-241-9822
Fax Number	:

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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