MEDICARE: KATHLEEN MARA EAGER-ARIZ LPC ASSOCIATE

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	89421	TX

General Provider Information

NPI Number	:	1598452153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN MARA EAGER-ARIZ LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	651 BALCONES DR
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-5935
Country	:	US
Telephone Number	:	830-623-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 PRIMERA DR APT 6
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-2050
Country	:	US
Telephone Number	:	830-623-7121
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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