MEDICARE: JUNTOS CAMINAREMOS INC.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10008	TX

General Provider Information

NPI Number	:	1922368422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUNTOS CAMINAREMOS INC.

Provider Business Mailing Address
First Line	:	3302 CHACOTA ST
Second Line	:	2A
City	:	LAREDO
State	:	TX
Zip	:	78046-7025
Country	:	US
Telephone Number	:	956-723-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	3302 CHACOTA ST
Second Line	:	2A
City	:	LAREDO
State	:	TX
Zip	:	78046-7025
Country	:	US
Telephone Number	:	956-723-4488
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. GRACIELA MARTINEZ VELA
Credential	:	NCAC I, LCDC, CART
Telephone Number	:	956-723-4488

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	05/18/2012

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