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NPI Code Detail

MEDICARE: GRACE IACUONE COUNSELING, PLLC

MEDICARE: GRACE IACUONE COUNSELING, PLLC
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
1101Y00000XCounselor62105TX

General Provider Information

NPI Number : 1093159824
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE IACUONE COUNSELING, PLLC
Provider Business Mailing Address
First Line : 4600 LOCKHILL SELMA RD STE 101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2186
Country : US
Telephone Number : 210-408-7300
Fax Number : 210-408-7303
Provider Business Practice Location Address
First Line : 4600 LOCKHILL SELMA RD STE 101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2186
Country : US
Telephone Number : 210-408-7300
Fax Number : 210-408-7303
Authorized Official
Title or Position : LICENSED PROFESSIONAL COUNSELOR
Name : MRS. GRACE IACUONE
Credential : LPC
Telephone Number : 210-408-7300
Provider Enumeration Date : 04/23/2013
Last Update Date : 04/23/2013

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