MEDICARE: JEANDELL RIVERA ARCILLA

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	80513	TX

General Provider Information

NPI Number	:	1053143321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANDELL RIVERA ARCILLA

Provider Business Mailing Address
First Line	:	2605 COTTAGE GROVE GREEN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2980
Country	:	US
Telephone Number	:	713-725-0910
Fax Number	:

Provider Business Practice Location Address
First Line	:	19627 INTERSTATE 45 STE 210
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-6028
Country	:	US
Telephone Number	:	281-901-0050
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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Directions to “ JEANDELL RIVERA ARCILLA ” Practice Location

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