MEDICARE: MS. MARY CONTRERAS 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	101Y00000X	Counselor	14729	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811055346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CONTRERAS LPC

Provider Business Mailing Address
First Line	:	3501 W COMMERCE ST STE 2
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3647
Country	:	US
Telephone Number	:	210-348-5775
Fax Number	:	210-593-1557

Provider Business Practice Location Address
First Line	:	3501 W COMMERCE ST STE 2
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3647
Country	:	US
Telephone Number	:	210-348-5775
Fax Number	:	210-593-1557

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/13/2024

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