MEDICARE: MS. ZORICELIS DAVILA 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	19746	TX

General Provider Information

NPI Number	:	1801803077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ZORICELIS DAVILA LPC

Provider Business Mailing Address
First Line	:	4200 SOUTH FWY
Second Line	:	SUITE 604
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1400
Country	:	US
Telephone Number	:	888-537-4621
Fax Number	:	888-537-4649

Provider Business Practice Location Address
First Line	:	4200 SOUTH FWY
Second Line	:	SUITE 604
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1400
Country	:	US
Telephone Number	:	888-537-4621
Fax Number	:	888-537-4649

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/09/2007

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