MEDICARE: MRS. NAN NELL OTOUPAL LIC CLIN SOC WORKER

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	1041C0700X	Clinical Social Worker

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
2	0071ME	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245310325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAN NELL OTOUPAL LIC CLIN SOC WORKER

Provider Business Mailing Address
First Line	:	102 WONDER WORLD DR # 304-146
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-6076
Country	:	US
Telephone Number	:	719-501-3337
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 WONDER WORLD DR # 304-146
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-6076
Country	:	US
Telephone Number	:	719-501-3337
Fax Number	:

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	12/19/2023

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