MEDICARE: MR. JUAN BAUTISTA ZAMBRANO LPC-I

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

General Provider Information

NPI Number	:	1386241693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN BAUTISTA ZAMBRANO LPC-I

Provider Business Mailing Address
First Line	:	2525 ELM ST APT 1910
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1476
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5344 ALPHA RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-3428
Country	:	US
Telephone Number	:	214-396-0259
Fax Number	:

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

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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Directions to “ MR. JUAN BAUTISTA ZAMBRANO LPC-I” Practice Location

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