Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 4849 | TX |
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1316227192 |
---|---|
Provider Name | Ernesto J Centeno |
First Address | San Antonio, TX 78255 |
Second Address | San Antonio, TX 78228-3267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2011 |
Last Update Date | 03/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4849 | TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS (01) | TX |