MEDICARE: LAURA ANNE SALAZAR LCPC

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	180.012547	IL

General Provider Information

NPI Number	:	1871115576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANNE SALAZAR LCPC

Provider Business Mailing Address
First Line	:	5226 LILLIAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5227
Country	:	US
Telephone Number	:	630-673-7983
Fax Number	:

Provider Business Practice Location Address
First Line	:	5226 LILLIAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5227
Country	:	US
Telephone Number	:	630-673-7983
Fax Number	:

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

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	05/15/2020

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