Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 77680 | TX |
Y | 101YP2500X | Professional Counselor | 77680 | TX |
NPI | 1003448291 |
---|---|
Provider Name | Leticia Rios Villareal |
First Address | San Antonio, TX 78230-2553 |
Second Address | San Antonio, TX 78230-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2020 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
77680 | LICENSED PROFESSIONAL COUNSELOR LICENSE (01) | TX |