MEDICARE: MRS. LETICIA ARELY CAMPOS LMSW

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	171M00000X	Case Manager/Care Coordinator	38386	TX

General Provider Information

NPI Number	:	1801070016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LETICIA ARELY CAMPOS LMSW

Provider Business Mailing Address
First Line	:	PO BOX 761884
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-6884
Country	:	US
Telephone Number	:	210-764-5540
Fax Number	:	210-764-5541

Provider Business Practice Location Address
First Line	:	1015 FERDINAND DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1364
Country	:	US
Telephone Number	:	210-764-5540
Fax Number	:	210-764-5541

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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