MEDICARE: ROY CECRLE MA, 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	69415	TX
2	101YM0800X	Mental Health Counselor	69415	TX
3	101YP2500X	Professional Counselor	69415	TX
4	101YP2500X	Professional Counselor	17071	CA

General Provider Information

NPI Number	:	1841782075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY CECRLE MA, LPC

Provider Business Mailing Address
First Line	:	925 E 3RD ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4906
Country	:	US
Telephone Number	:	682-521-6779
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 N TUSTIN AVE STE 100
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-2937
Country	:	US
Telephone Number	:	949-431-2225
Fax Number	:

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

Provider Enumeration Date	:	06/04/2018
Last Update Date	:	07/29/2025

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