Provider Demographics
NPI:1104122423
Name:CABALLERO, PRISCILLA MIA (LCDC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MIA
Last Name:CABALLERO
Suffix:
Gender:
Credentials:LCDC
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:MIA
Other - Last Name:CABALLERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, LCDC, LPC ASSO
Mailing Address - Street 1:12130 ALAMO RANCH PKWY APT 2612
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4010
Mailing Address - Country:US
Mailing Address - Phone:210-264-1940
Mailing Address - Fax:
Practice Address - Street 1:12130 ALAMO RANCH PKWY APT 2612
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4010
Practice Address - Country:US
Practice Address - Phone:210-264-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-03
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11117101YA0400X
TX95784101YM0800X
TX204990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health