MEDICARE: MRS. MARIA D. PRADO LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10310	TX

General Provider Information

NPI Number	:	1366652067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA D. PRADO LCDC

Provider Business Mailing Address
First Line	:	3905 BILLINGSLEY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-4808
Country	:	US
Telephone Number	:	281-200-9237
Fax Number	:	281-400-3549

Provider Business Practice Location Address
First Line	:	3905 BILLINGSLEY STREET
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-4808
Country	:	US
Telephone Number	:	281-200-9237
Fax Number	:	281-400-3549

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/21/2022

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