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NPI Code Detail

MEDICARE: MARY JANE NATIVIDAD MED LPC

MEDICARE: MARY JANE NATIVIDAD MED 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
1101YM0800XMental Health Counselor19403TX
2101Y00000XCounselor19403TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588753925
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JANE NATIVIDAD MED LPC
Provider Business Mailing Address
First Line : 7627 DERBY RUN
Second Line :
City : SELMA
State : TX
Zip : 78154-3936
Country : US
Telephone Number : 210-325-6874
Fax Number : 210-267-9072
Provider Business Practice Location Address
First Line : 401 E SONTERRA BLVD STE 375
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78258-4321
Country : US
Telephone Number : 210-325-6874
Fax Number : 210-267-9072
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 03/15/2024

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Directions to “ MARY JANE NATIVIDAD MED LPC” Practice Location

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