MEDICARE: ADAM SAUCEDA MA, 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	66428	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	66428	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1306110648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM SAUCEDA MA, LPC

Provider Business Mailing Address
First Line	:	8631 AUBERRY PATH
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4482
Country	:	US
Telephone Number	:	210-392-8402
Fax Number	:

Provider Business Practice Location Address
First Line	:	12030 BANDERA RD STE 108J
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4736
Country	:	US
Telephone Number	:	210-853-0503
Fax Number	:	888-307-5350

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

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	01/22/2020

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