MEDICARE: ERICA SOTO 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	84256	TX

General Provider Information

NPI Number	:	1568192284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA SOTO LPC

Provider Business Mailing Address
First Line	:	3540 WAYLAND DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3131
Country	:	US
Telephone Number	:	817-988-0828
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 BELLAIRE DR S
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1889
Country	:	US
Telephone Number	:	817-657-1115
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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