MEDICARE: JESSICA VERA-RIOS CRC, 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	225C00000X	Rehabilitation Counselor	00054532	TX
2	101YP2500X	Professional Counselor	59657	TX

General Provider Information

NPI Number	:	1871739920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA VERA-RIOS CRC, LPC

Provider Business Mailing Address
First Line	:	PO BOX 880
Second Line	:
City	:	ROMA
State	:	TX
Zip	:	78584-0880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3722 W HWY 83
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-5615
Country	:	US
Telephone Number	:	956-716-1558
Fax Number	:

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

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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