MEDICARE: JOHN LOUIS NECROTO

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	11844	TX
2	101YP2500X	Professional Counselor	71247	TX

General Provider Information

NPI Number	:	1386000750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LOUIS NECROTO

Provider Business Mailing Address
First Line	:	2634 PINE VILLAGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3824
Country	:	US
Telephone Number	:	713-806-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	2634 PINE VILLLAGE DRIVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-3824
Country	:	US
Telephone Number	:	713-806-8721
Fax Number	:

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

Provider Enumeration Date	:	01/14/2016
Last Update Date	:	01/14/2016

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Directions to “ JOHN LOUIS NECROTO ” Practice Location

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