MEDICARE: MEG CERVANTES 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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	83657	TX

General Provider Information

NPI Number	:	1871259937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEG CERVANTES LPC

Provider Business Mailing Address
First Line	:	7725 MARFA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7718
Country	:	US
Telephone Number	:	979-203-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 CENTRAL PARK AVE STE 200
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1566
Country	:	US
Telephone Number	:	979-203-8793
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/28/2023

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Directions to “ MEG CERVANTES LPC” Practice Location

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