MEDICARE: MARINDA LYNN PICON

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

General Provider Information

NPI Number	:	1518894138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINDA LYNN PICON

Provider Business Mailing Address
First Line	:	1409 7TH ST
Second Line	:
City	:	SHALLOWATER
State	:	TX
Zip	:	79363-5105
Country	:	US
Telephone Number	:	575-910-5332
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 GENOA AVE STE D
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-2708
Country	:	US
Telephone Number	:	806-855-3050
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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