Provider Demographics
NPI:1073184859
Name:LONGORIA, JANEL ROXANE (LPC)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:ROXANE
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 CEDAR SPRINGS RD APT 15
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1363
Mailing Address - Country:US
Mailing Address - Phone:469-500-0223
Mailing Address - Fax:
Practice Address - Street 1:4830 CEDAR SPRINGS RD APT 15
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1363
Practice Address - Country:US
Practice Address - Phone:469-500-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty