MEDICARE: MRS. DANA PEBBLE BORREMANS 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	101Y00000X	Counselor	13508	TX
2	101YP2500X	Professional Counselor	13508	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5079LC	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184739807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA PEBBLE BORREMANS LPC

Provider Business Mailing Address
First Line	:	1205 HWY 123, SUITE 303
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-353-0483
Fax Number	:	512-353-3725

Provider Business Practice Location Address
First Line	:	1205 HWY 123, SUITE 303
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7756
Country	:	US
Telephone Number	:	512-353-0483
Fax Number	:	512-353-3725

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	10/24/2013

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