MEDICARE: LETTY COUNSELING SERVICES INC.

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	16474	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407877293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LETTY COUNSELING SERVICES INC.

Provider Business Mailing Address
First Line	:	6354 EDGEMERE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3517
Country	:	US
Telephone Number	:	915-542-4200
Fax Number	:	915-542-4204

Provider Business Practice Location Address
First Line	:	6354 EDGEMERE BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3517
Country	:	US
Telephone Number	:	915-542-4200
Fax Number	:	915-542-4204

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	MRS. LETICIA GUTIERREZ
Credential	:	LPC
Telephone Number	:	915-542-4200

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/28/2011

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