MEDICARE: ROSA MONTELONGO

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	72748	TX

General Provider Information

NPI Number	:	1932555406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA MONTELONGO

Provider Business Mailing Address
First Line	:	3304 SE LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1113
Country	:	US
Telephone Number	:	817-984-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 SE LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1113
Country	:	US
Telephone Number	:	817-984-7545
Fax Number	:

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

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	05/13/2016

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Directions to “ ROSA MONTELONGO ” Practice Location

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