MEDICARE: MARIE MEJIA-JUSTICE 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	101Y00000X	Counselor	64994	TX

General Provider Information

NPI Number	:	1891065926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MEJIA-JUSTICE LPC

Provider Business Mailing Address
First Line	:	1219 S MOSS LAKE RD
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-1066
Country	:	US
Telephone Number	:	432-393-5934
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 S MAIN ST
Second Line	:	SUITE B
City	:	BIG SPRING
State	:	TX
Zip	:	79720-2519
Country	:	US
Telephone Number	:	432-393-5934
Fax Number	:

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

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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Directions to “ MARIE MEJIA-JUSTICE LPC” Practice Location

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