MEDICARE: MARY SAINT DUMLAO MED, LPC-S

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	18429	TX
2	101YS0200X	School Counselor		TX

General Provider Information

NPI Number	:	1124291216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SAINT DUMLAO MED, LPC-S

Provider Business Mailing Address
First Line	:	30903 VICKIE LN
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-5712
Country	:	US
Telephone Number	:	281-250-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	17510 HUFFMEISTER RD., SUITE 104
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-7831
Country	:	US
Telephone Number	:	281-250-1141
Fax Number	:

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

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	02/13/2009

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