MEDICARE: TERESA ESPINO

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	79248	TX

General Provider Information

NPI Number	:	1790401057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ESPINO

Provider Business Mailing Address
First Line	:	5908 POLO CLUB DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5908 POLO CLUB DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4545
Country	:	US
Telephone Number	:	817-470-6136
Fax Number	:

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

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	10/18/2022

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Directions to “ TERESA ESPINO ” Practice Location

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