MEDICARE: DELORES LEE MOWER 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	67900	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205173515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELORES LEE MOWER LPC

Provider Business Mailing Address
First Line	:	8202 MONTGOMERY OAK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239-2965
Country	:	US
Telephone Number	:	210-324-1069
Fax Number	:	210-324-1069

Provider Business Practice Location Address
First Line	:	1777 NE LOOP 410 STE 674
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5209
Country	:	US
Telephone Number	:	210-324-1069
Fax Number	:	210-324-1069

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	05/04/2015

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Directions to “ DELORES LEE MOWER LPC” Practice Location

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