MEDICARE: CINDY K DALMOLIN M.A., LMFT, LCDCI

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	6359	TX
2	106H00000X	Marriage & Family Therapist	201054	TX

General Provider Information

NPI Number	:	1104158005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINDY K DALMOLIN M.A., LMFT, LCDCI

Provider Business Mailing Address
First Line	:	PO BOX 814
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-0814
Country	:	US
Telephone Number	:	281-615-5862
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 COUNTY ROAD 90 STE 119
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4891
Country	:	US
Telephone Number	:	832-226-2688
Fax Number	:

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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