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NPI Code Detail

MEDICARE: MRS. MELISSA MARIE CANTU LCDC

MEDICARE: MRS. MELISSA MARIE CANTU LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1073948626
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELISSA MARIE CANTU LCDC
Provider Business Mailing Address
First Line : 519 E QUINCY ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78215-1605
Country : US
Telephone Number : 210-299-1614
Fax Number : 210-299-4595
Provider Business Practice Location Address
First Line : 519 E QUINCY ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78215-1605
Country : US
Telephone Number : 210-299-1614
Fax Number : 210-299-4595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2013
Last Update Date : 09/13/2013

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