MEDICARE: DAYNA QUEZADA ACOSTA 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	101YM0800X	Mental Health Counselor	77141	TX

General Provider Information

NPI Number	:	1831743442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYNA QUEZADA ACOSTA LPC

Provider Business Mailing Address
First Line	:	5959 GATEWAY BLVD W STE 120
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-779-1754

Provider Business Practice Location Address
First Line	:	5941 FIESTA DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5254
Country	:	US
Telephone Number	:	915-400-7655
Fax Number	:	915-974-3888

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

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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