MEDICARE: ANGELITA ROSA AGAPE

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	73647	TX

General Provider Information

NPI Number	:	1710558812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELITA ROSA AGAPE

Provider Business Mailing Address
First Line	:	14110 FAIRWAY OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1647
Country	:	US
Telephone Number	:	210-385-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	14110 FAIRWAY OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-1647
Country	:	US
Telephone Number	:	210-706-0770
Fax Number	:

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

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	01/31/2023

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