MEDICARE: NICK ENO AND ASSOCIATES

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	14804	TX
2	101YP2500X	Professional Counselor	14804	TX

General Provider Information

NPI Number	:	1619394632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICK ENO AND ASSOCIATES

Provider Business Mailing Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6036
Country	:	US
Telephone Number	:	214-949-2078
Fax Number	:	817-695-5195

Provider Business Practice Location Address
First Line	:	3901 ARLINGTON HIGHLANDS BLVD
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	TX
Zip	:	76018-6036
Country	:	US
Telephone Number	:	214-949-2078
Fax Number	:	817-695-5195

Authorized Official
Title or Position	:	PRESIDENT /CEO
Name	:	MR. NICHOLAS A ENO
Credential	:	MA
Telephone Number	:	214-949-2078

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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