Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 64094 | TX |
NPI | 1003184698 |
---|---|
Provider Name | Elizabeth Marie Villarreal |
First Address | San Antonio, TX 78212-2981 |
Second Address | San Antonio, TX 78212-5006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2011 |
Last Update Date | 21/06/2012 |