MEDICARE: MS. CARRIE J VISGER 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
1	101YM0800X	Mental Health Counselor	71828	TX

General Provider Information

NPI Number	:	1992453039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARRIE J VISGER LPC

Provider Business Mailing Address
First Line	:	1401 BALSAM WAY
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2388
Country	:	US
Telephone Number	:	512-983-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 N LOOP 1604 E STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1369
Country	:	US
Telephone Number	:	210-614-4990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2022
Last Update Date	:	04/02/2022

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