MEDICARE: JERHONDA KAYE SPAULDING LPC-A, NCC

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	91392	TX
2	101YP2500X	Professional Counselor	91392	TX

General Provider Information

NPI Number	:	1417648452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERHONDA KAYE SPAULDING LPC-A, NCC

Provider Business Mailing Address
First Line	:	9717 NOVACEK BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2123
Country	:	US
Telephone Number	:	202-306-8804
Fax Number	:

Provider Business Practice Location Address
First Line	:	9717 NOVACEK BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-2123
Country	:	US
Telephone Number	:	202-306-8804
Fax Number	:

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

Provider Enumeration Date	:	05/19/2023
Last Update Date	:	05/19/2023

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