MEDICARE: JEZIEL RIOS ELIZONDO 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	95361	TX

General Provider Information

NPI Number	:	1861343824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEZIEL RIOS ELIZONDO LPC

Provider Business Mailing Address
First Line	:	1020 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-1527
Country	:	US
Telephone Number	:	214-668-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 S CARRIER PKWY
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-1527
Country	:	US
Telephone Number	:	214-330-2488
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	03/13/2026

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