MEDICARE: MS. SONIA PASTRANA 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	101YP2500X	Professional Counselor	12932	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4165LC	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417980855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONIA PASTRANA LPC

Provider Business Mailing Address
First Line	:	1100 NASA PKWY STE 308
Second Line	:	HOUSTON
City	:	HOUSTON
State	:	TX
Zip	:	77058-3356
Country	:	US
Telephone Number	:	281-691-3700
Fax Number	:	281-857-6347

Provider Business Practice Location Address
First Line	:	1100 NASA PKWY
Second Line	:	SUITE 308
City	:	HOUSTON
State	:	TX
Zip	:	77058-3325
Country	:	US
Telephone Number	:	281-691-3700
Fax Number	:	281-857-6347

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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