MEDICARE: MS. DELMA A. FUENTES LPC, LMFT

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	106H00000X	Marriage & Family Therapist	004774-025514	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1522571	OTHER	TX	VALUE OPTIONS
2	3631LC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1588675201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELMA A. FUENTES LPC, LMFT

Provider Business Mailing Address
First Line	:	1919 OAKWELL FARMS PKWY
Second Line	:	SUITE 230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1777
Country	:	US
Telephone Number	:	210-822-4969
Fax Number	:	210-822-4919

Provider Business Practice Location Address
First Line	:	1919 OAKWELL FARMS PKWY
Second Line	:	SUITE 230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1777
Country	:	US
Telephone Number	:	210-822-4969
Fax Number	:	210-822-4919

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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