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NPI Code Detail

MEDICARE: ANNASTASIA CHANTEL VINCENT M. A.

MEDICARE: ANNASTASIA CHANTEL VINCENT M. A.
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
1101YP2500XProfessional Counselor89352TX

General Provider Information

NPI Number : 1982464806
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNASTASIA CHANTEL VINCENT M. A.
Provider Business Mailing Address
First Line : 4855 RIVERSTONE BLVD STE 102
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-4378
Country : US
Telephone Number : 832-722-1409
Fax Number :
Provider Business Practice Location Address
First Line : 22001 SOUTHWEST FWY STE 125
Second Line :
City : RICHMOND
State : TX
Zip : 77469-7118
Country : US
Telephone Number : 844-824-8775
Fax Number : 281-648-2200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2024
Last Update Date : 10/12/2025

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