MEDICARE: EDNA BALBOA M.ED., 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	75482	TX

General Provider Information

NPI Number	:	1518493279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA BALBOA M.ED., LPC

Provider Business Mailing Address
First Line	:	PO BOX 7153
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77248-7153
Country	:	US
Telephone Number	:	832-851-5883
Fax Number	:

Provider Business Practice Location Address
First Line	:	8831 LONG POINT RD STE 202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-3010
Country	:	US
Telephone Number	:	832-851-5883
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	03/26/2020

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