MEDICARE: SOUTH TEXAS COUNSELING & PSYCHOLOGICAL TESTING

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	19806	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083865075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS COUNSELING & PSYCHOLOGICAL TESTING

Provider Business Mailing Address
First Line	:	3505 BOCA CHICA BLVD
Second Line	:	SUITE 149
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4214
Country	:	US
Telephone Number	:	956-574-0951
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 BOCA CHICA BLVD
Second Line	:	SUITE 149
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4214
Country	:	US
Telephone Number	:	956-574-0951
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	ROBERTO DE ANDA
Credential	:	L.P.C.
Telephone Number	:	956-455-5983

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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Directions to “SOUTH TEXAS COUNSELING & PSYCHOLOGICAL TESTING ” Practice Location

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