MEDICARE: MRS. MCCAYLA BERRY MA, 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	101YP2500X	Professional Counselor	85724	TX

General Provider Information

NPI Number	:	1730887530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MCCAYLA BERRY MA, LPC

Provider Business Mailing Address
First Line	:	1834 NORCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2319
Country	:	US
Telephone Number	:	512-640-9448
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 W 22ND ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1968
Country	:	US
Telephone Number	:	713-380-1151
Fax Number	:

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

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	05/08/2024

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