MEDICARE: LARISSA VALERIANO MS, LPC ASSOCIATE

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	83623	TX

General Provider Information

NPI Number	:	1245985480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA VALERIANO MS, LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	6519 BENWOOD CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2436
Country	:	US
Telephone Number	:	210-890-8007
Fax Number	:

Provider Business Practice Location Address
First Line	:	6519 BENWOOD CRST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2436
Country	:	US
Telephone Number	:	210-890-8007
Fax Number	:

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

Provider Enumeration Date	:	02/16/2022
Last Update Date	:	02/16/2022

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