MEDICARE: DENIJA DELIC LPC, NCC

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	75539	TX

General Provider Information

NPI Number	:	1669969648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENIJA DELIC LPC, NCC

Provider Business Mailing Address
First Line	:	3900 MERRETT DR
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2920
Country	:	US
Telephone Number	:	817-361-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 MERRETT DR
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2920
Country	:	US
Telephone Number	:	817-361-2037
Fax Number	:

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	01/06/2023

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