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NPI Code Detail

MEDICARE: MRS. GRACE ELIZABETH IACUONE M.ED., LPC

MEDICARE: MRS. GRACE ELIZABETH IACUONE M.ED., 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
1101Y00000XCounselor62105TX

General Provider Information

NPI Number : 1982944336
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRACE ELIZABETH IACUONE M.ED., LPC
Provider Business Mailing Address
First Line : 414 COUNTRY WOOD DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78216-1612
Country : US
Telephone Number : 214-532-3505
Fax Number :
Provider Business Practice Location Address
First Line : 4600 LOCKHILL SELMA RD STE 101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78249-2186
Country : US
Telephone Number : 214-532-3505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2013
Last Update Date : 02/21/2013

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