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General NPI Number Information
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NPI Number | 1578348728
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Entity Type | Individual
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Provider Name | IRMA MAYTE CANDELARIO
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 8308 VAIL DR
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City | AMARILLO
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State | TX
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Zip | 79118-8126
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Country | US
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Telephone | 806-517-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 15 SCRANTON WAY
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City | LYNN
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State | MA
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Zip | 01904-2130
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Country | US
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Telephone | 806-517-5020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 88544
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License Number State | TX
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