MEDICARE: MISCHELE MAGLOTHIN 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	76641	TX

General Provider Information

NPI Number	:	1306381843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISCHELE MAGLOTHIN LPC

Provider Business Mailing Address
First Line	:	502 W MONTGOMERY ST # 199
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-8827
Country	:	US
Telephone Number	:	361-356-0119
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 W MONTGOMERY ST # 199
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-8827
Country	:	US
Telephone Number	:	361-356-0119
Fax Number	:

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	06/25/2025

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