MEDICARE: VASSARRIS COUNSELING

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
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1225677479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASSARRIS COUNSELING

Provider Business Mailing Address
First Line	:	PO BOX 202
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-0202
Country	:	US
Telephone Number	:	210-598-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W FM 78 STE 201
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3553
Country	:	US
Telephone Number	:	210-598-0040
Fax Number	:	210-598-0102

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER VASSELL
Credential	:	MA
Telephone Number	:	210-598-0040

Provider Enumeration Date	:	01/04/2020
Last Update Date	:	01/04/2020

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Directions to “VASSARRIS COUNSELING ” Practice Location

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