MEDICARE: MR. NICHOLAS A ENO 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	14804	TX

General Provider Information

NPI Number	:	1316183346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS A ENO LPC

Provider Business Mailing Address
First Line	:	1506 W PIONEER PKWY
Second Line	:	SUITE 105
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6230
Country	:	US
Telephone Number	:	214-418-8078
Fax Number	:	817-860-0027

Provider Business Practice Location Address
First Line	:	1506 W PIONEER PKWY
Second Line	:	SUITE 105
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6230
Country	:	US
Telephone Number	:	214-418-8078
Fax Number	:	817-860-0027

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

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/22/2008

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