MEDICARE: MARITZA WARDROP 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	101YM0800X	Mental Health Counselor	73466	TX

General Provider Information

NPI Number	:	1407575848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA WARDROP LPC

Provider Business Mailing Address
First Line	:	2403 BLUE ROSE DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-2903
Country	:	US
Telephone Number	:	713-305-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 SPACE PARK DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3468
Country	:	US
Telephone Number	:	281-333-2284
Fax Number	:

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

Provider Enumeration Date	:	08/26/2022
Last Update Date	:	08/26/2022

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