MEDICARE: MS. LYDIA M VALDES 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	64190	TX

General Provider Information

NPI Number	:	1275842767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYDIA M VALDES LPC

Provider Business Mailing Address
First Line	:	PO BOX 942
Second Line	:
City	:	MANCHACA
State	:	TX
Zip	:	78652-0942
Country	:	US
Telephone Number	:	512-994-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 PACK SADDLE PASS
Second Line	:	STE. 203
City	:	AUSTIN
State	:	TX
Zip	:	78745-1681
Country	:	US
Telephone Number	:	512-994-7181
Fax Number	:

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	10/17/2013

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