MEDICARE: MRS. BLANCA PALACIOS LPC-A

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	89451	TX
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1598040735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BLANCA PALACIOS LPC-A

Provider Business Mailing Address
First Line	:	5955 ALPHA RD # 1392
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1121
Country	:	US
Telephone Number	:	469-423-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	5955 ALPHA RD # 1392
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1121
Country	:	US
Telephone Number	:	469-423-5671
Fax Number	:

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	12/01/2022

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