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NPI Code Detail

MEDICARE: JADE ANN MENA LCDC

MEDICARE: JADE ANN MENA LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor9755TX

General Provider Information

NPI Number : 1124778295
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE ANN MENA LCDC
Provider Business Mailing Address
First Line : 1110 W WILLIAM CANNON DR STE 303
Second Line :
City : AUSTIN
State : TX
Zip : 78745-3188
Country : US
Telephone Number : 512-899-2100
Fax Number : 512-899-2205
Provider Business Practice Location Address
First Line : 1110 W WILLIAM CANNON DR STE 303
Second Line :
City : AUSTIN
State : TX
Zip : 78745-3188
Country : US
Telephone Number : 512-899-2100
Fax Number : 512-899-2205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2022
Last Update Date : 03/24/2022

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Directions to “ JADE ANN MENA LCDC” Practice Location

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