MEDICARE: MARY AMES M.A., M.ED, 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
1	101YP2500X	Professional Counselor	71306	TX

General Provider Information

NPI Number	:	1679077879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY AMES M.A., M.ED, LPC

Provider Business Mailing Address
First Line	:	3027 DERRICK LN
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3673
Country	:	US
Telephone Number	:	832-723-9459
Fax Number	:

Provider Business Practice Location Address
First Line	:	9660 HILLCROFT ST STE 200B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-3870
Country	:	US
Telephone Number	:	832-723-9459
Fax Number	:

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

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	03/21/2018

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