MEDICARE: GLORIA AURORA CHAMPION 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	63471	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265735856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA AURORA CHAMPION LPC

Provider Business Mailing Address
First Line	:	8310 LAMOND LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3195
Country	:	US
Telephone Number	:	281-861-7326
Fax Number	:

Provider Business Practice Location Address
First Line	:	12816 WILLOW CENTRE DR STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3034
Country	:	US
Telephone Number	:	346-235-3939
Fax Number	:	346-235-3938

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

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	02/05/2022

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