MEDICARE: SYN'TORIA JA'LECIA BRANCH MA, LPC-A, NCC

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	97184	TX

General Provider Information

NPI Number	:	1023902541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYN'TORIA JA'LECIA BRANCH MA, LPC-A, NCC

Provider Business Mailing Address
First Line	:	407 SANDALL ST
Second Line	:
City	:	NAVASOTA
State	:	TX
Zip	:	77868-3757
Country	:	US
Telephone Number	:	936-870-8467
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 1/2 N MAIN ST STE 210
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-3379
Country	:	US
Telephone Number	:	936-870-8467
Fax Number	:

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	06/09/2025

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