MEDICARE: MARLENE IGLESIAS-GONZALES 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	73189	TX

General Provider Information

NPI Number	:	1881144608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE IGLESIAS-GONZALES LPC

Provider Business Mailing Address
First Line	:	1311 CHISHOLM TRAIL RD STE 201
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-546-6798
Fax Number	:	512-591-0049

Provider Business Practice Location Address
First Line	:	1311 CHISHOLM TRAIL RD STE 201
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-546-6798
Fax Number	:	512-591-0049

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

Provider Enumeration Date	:	10/05/2016
Last Update Date	:	10/20/2021

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