MEDICARE: MR. ALFONSO PADILLA LPC

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	60272	TX

General Provider Information

NPI Number	:	1093990442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFONSO PADILLA LPC

Provider Business Mailing Address
First Line	:	5053 FORT CLARK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2435
Country	:	US
Telephone Number	:	512-431-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	5053 FORT CLARK DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-2435
Country	:	US
Telephone Number	:	512-431-0706
Fax Number	:

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

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	06/13/2014

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