MEDICARE: MR. MARCO T VILLEGAS 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	19763	TX

General Provider Information

NPI Number	:	1699963348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCO T VILLEGAS LPC

Provider Business Mailing Address
First Line	:	2222 WESTERN TRAILS BLVD
Second Line	:	SUITE 203
City	:	AUSTIN
State	:	TX
Zip	:	78745-1682
Country	:	US
Telephone Number	:	512-743-5894
Fax Number	:	512-291-4795

Provider Business Practice Location Address
First Line	:	2222 WESTERN TRAILS BLVD
Second Line	:	SUITE 203
City	:	AUSTIN
State	:	TX
Zip	:	78745-1682
Country	:	US
Telephone Number	:	512-743-5894
Fax Number	:	512-291-4795

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	11/05/2020

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