MEDICARE: VERONICA CARBAJAL 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	101YM0800X	Mental Health Counselor	70438	TX
2	101Y00000X	Counselor	70438	TX

General Provider Information

NPI Number	:	1164803110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA CARBAJAL LPC

Provider Business Mailing Address
First Line	:	7801 OAKMONT BLVD STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4242
Country	:	US
Telephone Number	:	682-841-1475
Fax Number	:	682-708-3775

Provider Business Practice Location Address
First Line	:	7801 OAKMONT BLVD STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4242
Country	:	US
Telephone Number	:	682-841-1475
Fax Number	:	682-708-3775

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	11/01/2023

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