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NPI Code Detail

MEDICARE: RUBEN SAUCEDA JR. LPC-A

MEDICARE: RUBEN SAUCEDA JR. LPC-A
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
1101YM0800XMental Health CounselorTX

General Provider Information

NPI Number : 1174275051
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUBEN SAUCEDA JR. LPC-A
Provider Business Mailing Address
First Line : 3030 ELIZABETH ST APT 430
Second Line :
City : DALLAS
State : TX
Zip : 75204-2090
Country : US
Telephone Number : 212-786-2003
Fax Number :
Provider Business Practice Location Address
First Line : 3300 OAK LAWN AVE STE 601
Second Line :
City : DALLAS
State : TX
Zip : 75219-4439
Country : US
Telephone Number : 212-786-2003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2022
Last Update Date : 01/22/2022

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