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NPI Code Detail

MEDICARE: OLGA J VIDAL LPC

MEDICARE:   OLGA J VIDAL  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
1101Y00000XCounselor17141TX

General Provider Information

NPI Number : 1881701613
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLGA J VIDAL LPC
Provider Business Mailing Address
First Line : 1309 MELISSA OAKS LN
Second Line :
City : AUSTIN
State : TX
Zip : 78744-7965
Country : US
Telephone Number : 512-636-9436
Fax Number :
Provider Business Practice Location Address
First Line : 3518 FM 973
Second Line :
City : DEL VALLE
State : TX
Zip : 78617-3627
Country : US
Telephone Number : 512-247-4746
Fax Number : 512-247-2447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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Directions to “ OLGA J VIDAL LPC” Practice Location

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