MEDICARE: HAVANNAH MARCELA CASCOS 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	88401	TX

General Provider Information

NPI Number	:	1134987092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAVANNAH MARCELA CASCOS LPC

Provider Business Mailing Address
First Line	:	5205 CLEARVIEW DR
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-3818
Country	:	US
Telephone Number	:	956-521-8217
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 E RAILROAD AVE
Second Line	:
City	:	PORT ISABEL
State	:	TX
Zip	:	78578-4133
Country	:	US
Telephone Number	:	956-451-8113
Fax Number	:

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

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	04/09/2024

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