MEDICARE: CREER COUNSELING CONCEPTS, PC

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	101YP2500X	Professional Counselor	16111	TX

General Provider Information

NPI Number	:	1992014278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREER COUNSELING CONCEPTS, PC

Provider Business Mailing Address
First Line	:	PO BOX 684
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-0684
Country	:	US
Telephone Number	:	361-389-1678
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W SAINT PETER AVE
Second Line	:
City	:	SAN DIEGO
State	:	TX
Zip	:	78384-3049
Country	:	US
Telephone Number	:	361-389-1678
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALISSA IDETTE GARCIA
Credential	:	LCDC
Telephone Number	:	361-389-1678

Provider Enumeration Date	:	10/04/2010
Last Update Date	:	03/17/2011

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