MEDICARE: MRS. MERCEDES LUDIVINA CLEMENT LPCI

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	84156	TX

General Provider Information

NPI Number	:	1609474634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERCEDES LUDIVINA CLEMENT LPCI

Provider Business Mailing Address
First Line	:	6265 39TH ST
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-4614
Country	:	US
Telephone Number	:	409-962-4400
Fax Number	:	409-962-4412

Provider Business Practice Location Address
First Line	:	6265 39TH ST
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-4614
Country	:	US
Telephone Number	:	409-962-4400
Fax Number	:	409-962-4412

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/13/2020

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