MEDICARE: MRS. MARY CLARA SOSA 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	101YM0800X	Mental Health Counselor	79832	TX

General Provider Information

NPI Number	:	1245849553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CLARA SOSA LPC

Provider Business Mailing Address
First Line	:	1711 WOODLAND DR
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6295
Country	:	US
Telephone Number	:	956-337-2767
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 W DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3439
Country	:	US
Telephone Number	:	956-369-7997
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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